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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EAST\42435575.1 5/7/09

000125-000674

POWER OF ATTORNEY

AND

DESIGNATION OF TEMPORARY

GUARDIAN FOR MINOR CHILD

I, ____________________________________, the mother/father of 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 not able 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 all rights 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 my child in the appropriate educational institutions, obtain

access to my child’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 United States of America by air and/or ground transportation; to

accompany my child on any such trips; and to make any and all related arrangements on behalf

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

3. Health Care. To inspect and disclose any information relating to the physical

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

waivers and releases required by a hospital or physician; to authorize my child’s admission to or

discharge from any hospital or other medical care facility (including transfer to another facility);

to consult with any provider 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 may exercise any of these powers at any time that I am unavailable to

exercise such authority. Any person may deal with the Guardian in full reliance that this Power

of Attorney and Designation of Temporary Guardian for Minor Child has not been revoked and

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

written statement to that effect.

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000125-000674

STATEMENT OF ADDITIONAL DESIRES,

SPECIAL PROVISIONS AND LIMITATIONS

_______________________________________________________________________________

This Power of Attorney and 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 mentally competent 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, upon the first to occur of (i) my death, (ii) such time

as I become incapacitated (as such term is defined for purposes of Maryland 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 to serve as the Guardian of my child’s

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

Notwithstanding the foregoing, this Power of Attorney and Designation of Temporary

Guardian for Minor Child shall not be construed as a waiver of my parental rights, and I retain

the right to revoke this Power of Attorney and Designation of Temporary Guardian for Minor

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 Notary Public of the jurisdiction aforesaid, personally appeared

___________________________ and acknowledged the foregoing Power of Attorney and

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

As witness my hand and notarial seal.

______________________________

Notary Public

My Commission Expires: ________

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000125-000674

ACCEPTANCE OF DESIGNATION AS GUARDIAN FOR MINOR CHILD

I, _________________________, hereby acknowledge that I have been designated to

serve as the Guardian 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 and property of __________________________ and

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

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 Maryland guardianship law), or (iii) such time as

_____________________ is otherwise unavailable to care for _________________ and

consents in writing, before two witnesses, to the appointment of a 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: _________________________