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Get Minor Child Power Of Attorney Form

R.S. 2. To authorize any and all medical and dental care for the health and well being of the medical and dental exams and tests x-rays surgeries anesthesia and hospital care. This Special Power of Attorney does not give the Attorney in Fact the power to consent to the marriage or adoption of the child or incapacitated person. earlier by the parent or guardian in writing. DELEGATION OF POWER BY PARENT OR GUARDIAN PURSUANT TO 15-14-105 C. R.S. I full name parent or guardian of the minor child ren or incapacitated person s named below Full Name of Child Incapacitated Person or Date of Birth Relationship I hereby authorize and appoint name of person as Attorney in Fact for me with full authority to act in my place as follows 1. To perform any and all acts necessary for the day-to-day care custody education recreation and property of the above-named minor child or incapacitated person consistent with the provision of 15-14-105 C. R.S. 2. To authorize any and all medical and dental care for the health and well being of the medical and dental exams and tests x-rays surgeries anesthesia and hospital care. DELEGATION OF POWER BY PARENT OR GUARDIAN PURSUANT TO 15-14-105 C. R*S* I full name parent or guardian of the minor child ren or incapacitated person s named below Full Name of Child Incapacitated Person or Date of Birth Relationship I hereby authorize and appoint name of person as Attorney in Fact for me with full authority to act in my place as follows 1. To perform any and all acts necessary for the day-to-day care custody education recreation and property of the above-named minor child or incapacitated person consistent with the provision of 15-14-105 C. R*S* 2. To authorize any and all medical and dental care for the health and well being of the medical and dental exams and tests x-rays surgeries anesthesia and hospital care. This Special Power of Attorney does not give the Attorney in Fact the power to consent to the marriage or adoption of the child or incapacitated person* earlier by the parent or guardian in writing. In any case the authority granted herein shall not be valid for more than 12 months from the date of this document. Date Parent/Guardian Signature Subscribed and affirmed or sworn to before me in the County of State of this day of 20. My Commission Expires Notary Public/Clerk JDF 751 3/08 DELEGATION OF POWER BY PARENT OR GUARDIAN PURSUANT TO 15-14-105 C. DELEGATION OF POWER BY PARENT OR GUARDIAN PURSUANT TO 15-14-105 C. R*S* I full name parent or guardian of the minor child ren or incapacitated person s named below Full Name of Child Incapacitated Person or Date of Birth Relationship I hereby authorize and appoint name of person as Attorney in Fact for me with full authority to act in my place as follows 1. To perform any and all acts necessary for the day-to-day care custody education recreation and property of the above-named minor child or incapacitated person consistent with the provision of 15-14-105 C. To perform any and all acts necessary for the day-to-day care custody education recreation and property of the above-named minor child or incapacitated person consistent with the provision of 15-14-105 C. R*S* 2. To authorize any and all medical and dental care for the health and well being of the medical and dental exams and tests x-rays surgeries anesthesia and hospital care. .

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