ARKANSAS MINOR (CHILD) POWER OF ATTORNEY
TO ALL WHOM THESE PRESENTS ARE KNOWN:
That I, ___________________ (Parent), of ___________________ County,
Arkansas, being the natural mother/father of ___________________ (hereafter the
C
hild) appoint ___________________ (Agent) of ___________________ County,
Arkansas, my true and lawful attorney-in-fact for me and in my name, place
and stead
and in my behalf, and to do and perform all of the following responsibilities and have
all the rights in connection therewith:
1.
Perform and act as and for me in a parental capacity as and to the child;
2.
Give consent and permission for any kind of medical care and treatment, and to
sign any papers to have the child admitted to a hospital for such purpose, or as
may be required to maintain the health of the child;
3.
Give consent and permission for enrollment in and admission to school and to
resolve problems arising from school attendance, and to sign any papers necessary
for such purpose or sign other documents relating to the child's welfare at school;
4.
Perform any act necessary to obtain relief or aid that might benefit the child;
5.
Perform any other acts for support, health, and general care of the child as may be
required or necessary.
6.
I, ___________________ (Parent), do hereby give and grant to
___________________ (Agent), my said Attorney-in- fact, full power and
authority to do and perform any and all acts required to protect and promote the
welfare of the child, as fully and for all intents and purposes as I might or could do
if I were personally present at the time thereof, hereby ratifying and confirming all
that my said Attorneys may or shall lawfully
do or cause to be done by virtue of this Power-of-Attorney and the rights and
powers herein granted.
7.
This Power of Attorney appointing ___________________ (Agent) as my
attorney-in-fact performing and acting for me in a parental capacity for my child,
___________________ (Child), will be revoked automatically on the ____ day
of ___________________, 20____ (Date of Revocation).
8.
It is not my intention to relinquish my parental rights in and to my child.
IN TESTIMONY WHEREOF, I have hereunto set my hand this ____ day of
___________________, 20____.
STATE OF ARKANSAS )
) ss
COUNTY OF )
Signature of Parent/Guardian
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ____ day
of ___________________
, 20____.
Notary Public
My Commission Expires:
(S E A L)
IF YOU WANT A REVOCATION DATE IN ADVANCE:
On this ____ day of ___________________, 20____, before me personally came parent, to
me known to be the person described in and who executed the foregoing instrument, and
acknowledged that he/she executed the same as a free act and deed, and that
___________________
(Parent) is the mother/father of said children.