Fillable Printable Power of Attorney and Designation of Temporary Guardian for Minor Child - Maryland

Power of Attorney and Designation of Temporary Guardian for Minor Child - Maryland

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000125-000674

POWER OF ATTORNEY

AND

DESIGNATION OF TEMPORARY

GUARDIAN FOR MINOR CHILD

I, ____________________________________, the mother/fatherof my child,

_________________________________(“my child”), appoint and authorize

______________________________________ to serve as the Guardian of the person and

property of my child at any time I am unavailable to exercise the authority provided for herein.

If _________________________ is notable or willing to serve as my child’s Guardian, I

appoint ____________________________ to serve as my child’s Guardian instead.

I hereby authorize the Guardian to exercise any and allrights and responsibilities and do

any and all acts appropriate for a legal Guardian of a minor child including, but not limited to,

the following:

1. Education. To enroll mychild in the appropriate educational institutions,obtain

access to mychild’s academic records, authorize my child’s participation in school activities and

make any and all other decisions related to my child’s education.

2. Travel. To make travel arrangements on behalf of my child for destinations both

inside and outside of the UnitedStates of America by air and/or ground transportation; to

accompany mychild on anysuch trips; and tomake any and all related arrangements on behalf

of my child including, but not limited to, hotel accommodations.

3. Health Care. To inspect and discloseany informationrelating to the physical

and mental health of my child; to make anyandall health care decisions; to sign documents,

waivers and releasesrequired bya hospital or physician; to authorize my child’s admission to or

discharge from anyhospital or othermedical carefacility(including transfer to another facility);

to consult with anyprovider of health care; to consent to the provision, withholding,

modification or withdrawal of any health care procedure; and to make any and all other decisions

related to my child’s health care needs.

The Guardian mayexercise anyof these powers at any time that Iamunavailable to

exercise suchauthority. Anypersonmay deal with the Guardian in full reliance that thisPower

of Attorney and Designation of Temporary Guardian for Minor Child has notbeen revoked and

that Iam then unavailable to exercise the authority provided for herein, if the Guardian submits a

written statement to that effect.

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STATEMENTOFADDITIONAL DESIRES,

SPECIALPROVISIONS AND LIMITATIONS

_______________________________________________________________________________

This Power of Attorneyand Designation of Temporary Guardian for Minor Child shall

not be affected by my disability or incapacity. The authority granted herein shall continue during

any period while I may be disabled, incapacitated or unavailable.

I am emotionally and mentallycompetent to make this Power of Attorney and

Designation of Temporary Guardian for Minor Child, and I understand its purpose and effect.

It is my intent and desire that, uponthe first to occur of (i) my death, (ii) such time

as I become incapacitated (as such term is defined for purposes ofMaryland guardianship

law), or (iii) such time as I am otherwise unavailable to care for my child and consent in

writing, before two witnesses, to the appointment of a legal guardian,

______________________ (or, if he/she is unable to serve,

______________________________) be appointed toserve as the Guardianof my child’s

person and property, without bond, by the Court having appropriate jurisdiction.

Notwithstanding the foregoing,this Power of Attorneyand Designationof Temporary

Guardian for Minor Child shallnot be construed as a waiver of myparental rights, and I retain

the right to revoke this Power of Attorneyand Designation of Temporary Guardian forMinor

Child at any time.

WITNESS:

______________________________ ___________________________________

Print Name: ____________________ Print Name: _________________________

Date: _________________________ Date: ______________________________

______________________________

Print Name: ____________________

Date: _________________________

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STATE OF MARYLAND: TO WIT

I hereby certify that on this_________day of ______________________, 2009, before

me, the subscriber, a NotaryPublic of the jurisdictionaforesaid, personally appeared

___________________________ and acknowledged the foregoing Power of Attorneyand

Designation of Temporary Guardian for Minor Child to be his/her act and deed.

As witness my hand and notarial seal.

______________________________

NotaryPublic

My Commission Expires: ________

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000125-000674

ACCEPTANCE OF DESIGNATION AS GUARDIAN FOR MINOR CHILD

I, _________________________, herebyacknowledge that Ihave been designated to

serve as theGuardian of the person and property of _______________________________ by

his/her mother/father, __________________________, pursuant to the foregoing Power of

Attorney and Designation of Temporary Guardian for Minor Child. I hereby accept said

designation as the Guardian of the person andproperty of__________________________ and

agree to begin serving in such capacity at any time ________________________ is availableto

exercise the authority provided for therein. In addition, upon the first to occur of(i) the death

of ____________________, (ii) such time as _____________________ becomes incapacitated

(as such term is defined for purposes of Marylandguardianship law), or (iii) such time as

_____________________ is otherwise unavailable to care for _________________ and

consents inwriting, before two witnesses, to the appointment ofa legal guardian, I agree to

serve as the legal Guardian of the person and property of _______________________.

WITNESS:

______________________________ ___________________________________

Print Name: ____________________ Print Name: _________________________

Date: _________________________ Date: ______________________________

______________________________

Print Name: ____________________

Date: _________________________