Fillable Printable Temporary Power of Attorney for the Care of Children - Florida

Temporary Power of Attorney for the Care of Children - Florida

TEMPORARY POWER OF ATTORNEY FOR THE CARE OF CHILDREN

KNOW ALL PERSONS BY THESE PRESENTS:

We ______________________________________________________ ("Father") and ______________________________________ ("Mother"), jointly

Referred to as "Parents" or "Principals", maintaining an address at: ________________________________________ hereby make and

appoint ___________________________________ ("Attorney-in-Fact") maintaining an address at: _____________________________________

As our true and lawful agent and attorney-in-fact for us and in our name, and in our behalf to act as the guardian of our minor

child/children:

Name: _________________________________ born on __________ Name: _________________________________ born on __________

The above named Attorney-in-Fact shall have the power and authority to act entirely in loco parentis and to do all acts

Necessary or desirable for maintaining the health, education, and welfare of our above named child/children, including, but

Not limited to, the powers to:

1. Provide for, approve, authorize and decline any health care at any hospital or other institution; employ any physicians,

dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose

the contents of any medical records; execute any consent, release or waiver of liability required by medical, dental or

other health authorities incident to the provision of medical, surgical or dental care to our child/children. Health care

shall include but not be limited to the administration of anesthesia, X-ray examination, and performance of

operations, diagnostic and other procedures.

2. Determine the education needs of our child/children and to register and enroll our child/children in any educational

programs, schools and extracurricular activities; review any school records of the child/children; allow our

child/children to participate in activities and events offered by any group, organization or educational facility.

3. Maintain the customary living standard of the child/children, including, but not limited to, provisions of living

quarters, food, clothing, entertainment and other customary matters.

4. This temporary Power Of Attorney is in effect from (date) ________________________ until (date) _____________________________.

_________________________________________________ ______________________________________________

Father’s Signature Mother’s Signature

______________________________ _____________________________

Witness #1 Printed Name Witness #2 Printed Name

________________________________________________ _______________________________________________

Address Address

________________________________________________ _______________________________________________

Signature Signature

STATE OF FLORIDA

COUNTY OF COLLIER

The foregoing instrument was acknowledged before me this ____________ day of _________________, 20_______ by

Notary Public Signature & Printed Name

State of Florida

My Commission Expires: ________________________________________ (seal)