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POWER OF ATTORNEY
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,
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of Attorney and Designation of Temporary Guardian for Minor Child has not been revoked and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.