This Durable Power Of Attorney for Care of Children is used by individuals located in New Hampshire to appoint an Attorney-in-Fact to take care of the principal's children and to make decisions regarding the children's education and health care. This form grants the Attorney-in-Fact the right to participate in decisions regarding the children's education and health care and to sign documents regarding such matters. The power of attorney becomes effective when the document is executed and remains in effect in event of the principal's incapacity. This document contains some of the standard powers typically included in a power of attorney for care of children, but can be customized to fit the specific needs of the principal.
Docstoc Legal Agreements This Durable Power Of Attorney for Care of Children is used by individuals located in New Hampshire to appoint an Attorney-in-Fact to take care of the principal's children and to make decisions regarding the children's education and health care. This form grants the Attorney-in-Fact the right to participate in decisions regarding the children's education and health care and to sign documents regarding such matters. The power of attorney becomes effective when the document is executed and remains in effect in event of the principal's incapacity. This document contains some of the standard powers typically included in a power of attorney for care of children, but can be customized to fit the specific needs of the principal. ® DISCLAIMERS: ALL INFORMATION AND FORMS ARE PROVIDED “AS IS” WITHOUT ANY WARRANTY OF ANY KIND, EXPRESS, IMPLIED, OR OTHERWISE, INCLUDING AS TO THEIR LEGAL EFFECT AND COMPLETENESS. 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All Rights Reserved DURABLE POWER OF ATTORNEY FOR CARE OF CHILDREN KNOW ALL PERSONS BY THESE PRESENTS: That pursuant to the New Hampshire Code I, _______________________________ [Instruction: Insert the name of the principal] (hereinafter referred to as “Principal”), residing at ______________________________________ [Instruction: Insert the address of principal] execute this Durable Power of Attorney and do hereby make, constitute, and appoint: ___________________________________ [Instruction: Insert the name of agent] (hereinafter referred to as “Attorney-in-Fact”), residing at __________________________ [Instruction: Insert the address of agent], as my Attorney-in-Fact TO ACT IN MY NAME, PLACE, AND STEAD in any lawful way with respect to the care and custody of my child(ren): [Instruction: Insert the name of child(ren)] a. _______________________________ b. _______________________________ c. _______________________________ d. _______________________________ 1. Effectiveness of Power of Attorney: This instrument is to be construed and interpreted as a General Durable Power of Attorney for the following purposes: a. To participate in decisions regarding my child(ren), his/her/their education, including attending conferences with his/her/their teachers or any other educational authorities, granting permission for his/her/their participation in school trips and other activities, and making any other decisions and executing any documents pertinent to his/her/their education. b. To endorse and execute any document necessary for the performance of the powers granted by this document, including, but not limited to, consent forms, releases, waivers, insurance documents, claims, agreements, contracts, and legal documents. c. To grant permission and consent to my child(ren) participating in any activity sponsored by any group, association, or organization which activity my Attorney-in- Fact may deem appropriate. d. To make health care decisions on behalf of my child(ren), including making decisions regarding his/her/their medical or dental care, whether routine or emergency in nature, including admissions to hospitals or other institutions; to consent to, to refuse to consent to, or to withdraw consent to the provision of any care, tests, treatment, surgery, service, or procedure to maintain, diagnose, or treat a physical or mental condition, as well as the right to sign such medical forms as may be necessary to carry out such decisions; to talk with health care personnel who may be treating my child(ren) and to examine his/her/their medical records and to consent to the disclosure of such records in circumstances Attorney-in-Fact may deem appropriate; © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 2 to file claims for medical insurance and to obtain information from any insurance company with respect to any policy of health or medical insurance under which my child(ren) is/are insured; provided however, that my Attorney-in-Fact shall not be required to execute any documents which would involve incurring any personal liability for any such treatment and care, and I affirm that I will be responsible for payment for any such care or treatment consented to by my Attorney-in-Fact that is not covered by insurance. e. Request, ask, demand, sue, and take any or all legal steps necessary on behalf of my child(ren) 2. Effective Date: This Power of Attorney shall become effective when I sign and execute it below. Unless sooner revoked or terminated by me, this Power of Attorney shall become null and void on this ____ [Month] ____ [Date], 20____. [Year] [Instruction: Insert the expiration date] 3. Period: This Power of Attorney shall remain in full force and effect until the date stated in Paragraph 2, and any party dealing with my Attorney-in-Fact during such time shall be fully protected and is hereby discharged, released, and indemnified from so doing in respect of any matter relating hereto unless such particular party shall have received prior notice in writing of the revocation of this Power of Attorney. 4. Disability/Incapacitation/Incompetence: This Power of Attorney will continue to be effective even if I become disabled, incapacitated, or incompetent. 5. Severability: If any part of this document is held to be invalid, illegal, or unenforceable under applicable laws, then the remaining parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. 6. Compensation: Attorney-in-Fact shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. By signing here, I indicate that I am fully informed as to the content of this document and understand the full import of this grant of power to Attorney-in-Fact named herein. IN WITNESS WHEREOF, I hereunto set our hands and seals on ____ [Month] ____ [Date], 20____ [Year] _______________________ Signature of principal _______________________ Signature of agent © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 3 Witness signature #1 : ________________________ Name : ________________________ Address : ________________________ Witness signature #2 : ________________________ Name : ________________________ Address : ________________________ © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 4 ACKNOWLEDGEMENT State of New Hampshire County of __________________ [Instruction: Insert county] I, the undersigned, a Notary Public, in and for said County, in said State, hereby certify that __________________________ [Instruction: Insert name of principal], whose name is signed to the foregoing Power of Attorney and who is known to me, acknowledged before me on this day, that, being fully informed of the contents of the foregoing instrument, he executed the same voluntarily on the day the same bears date. Given under my hand and official seal this the ________ [Date] day of ________ [Month], ____ [Year]. ____________________________________ Notary Public My commission expires: _______________ (NOTARIAL SEAL) © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 5
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