_______________________________________________________________, the “parent”” of _____________________________________________________________, herewith appoints ______________________________ of _____________________________, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to do the following acts:

To act as the guardian of the person of my minor children:
______________________________________________________________________.

including the right to act entirely in loco parentis; including the authority to approve or to decline medical treatment of any kind for the child and including the right to review medical records or school records of the child.

This power of attorney shall be in effect from ________________ to ___________________.

_____________________________________________________
_______________________________, As Principal

STATE OF ______________________

COUNTY OF _______________________
_______________________________ personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.

Dated: _______________________________

__________________________________________
Notary Public
Commission Expires:

Power of Attorney, Simple
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. This is a simple but powerful Power of Attorney for care of your children that has a specific time period. An important feature of this form is the automatic termination date at the end of the period. You can adapt this Power of Attorney to relate to many matters where you want someone to serve as your proxy.

1. Make sure to limit the time period in the document itself for your own protection. Remember, you can always renew the Power of Attorney, should you want to do so.
2. A notary is suggested to be sure the Power of Attorney is honored in a crisis. Authorities love the legal niceties; this gives it to them so your agent with the Power of Attorney can act promptly and effectively.

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