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 __________
Name: _________________________________ born on __________ Name: _________________________________ born on __________
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
The
foregoing instrument was acknowledged before me this ____________ day of _________________, 20_______ by
Notary Public Signature & Printed Name
State of Florida
My Commission Expires: ________________________________________ (seal)
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