Whereas, ______________________ and ___________________, are the parent and natural guardians of the following child (ren):
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I designate _____________ of ___________, _________ to act as guardian of the minor child (ren) stated above upon my incapacity to so act.

Should _____________ be unable or unwilling to serve, I nominate _____________ of _________, _________ to act as the guardian of the minor children in the place of _____________.

Upon my disability, the designated guardian shall have the following authority:
a) Residential custody of the minor child (ren);
b) Approve medical treatment of any kind or type or to disapprove the same within the bounds of the law;
c) Designate schooling for the minor children, and access to any and all of their educational records;
d) Generally act in loco parentis.

In the event that I am the custodian of any property for the minor children under the Uniform Transfer to Minor’s Act, or the Uniform Gifts to Minors Act or similar statute, I designate the guardian or successor guardian to act as custodian for all such custodial property.

In the event that formal legal proceedings are commenced to establish a guardian for the child, it is my desire that the guardians mentioned herein have priority in appointment.

The failure to list an individual as a guardian or successor guardian is intentional.

Dated: __________________________

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Principal(s)

STATE OF ________________
COUNTY OF _______________

Before me, the undersigned authority personally appeared the above signatory (signatories) who acknowledged to me execution of this durable power of attorney.

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Notary
Commission Expires:

Guardian of Minor Children, Conditional
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. This document is a good well care document to have to put your financial affairs in order. It permits the rapid assumption of authority should an accident or other unexpected circumstance impair your ability to act as a parent. This is a particularly important document for single parents. The designated guardian (s) need not sign the document. It is up to you whether you wish to inform these people of this circumstance.

Unless you engage in dangerous occupations such as a soldier, high altitude climber, or like occupation, you are unlikely to have need of this document. But, if you do work in a high-risk occupation, and are a single parent, this is an important document for your children’s protection and smooth transition should something happen to you.

The notary step expedites matters since courts like notaries and official documentation of this kind. Make multiple copies. Be sure they are readily available should something happen to you, otherwise they will lose their effectiveness.

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