Docstoc Legal Agreements
This Durable Power of Attorney form is used by individuals located in Wisconsin to appoint
an Attorney-in-Fact and gives the Attorney-in-Fact broad powers to act on the principal's
behalf. This form grants the Attorney-in-Fact the right to speak or act on the principal's
behalf, including the power to lease or sell real estate or personal property, to collect any
money owed to the principal, and to sign documents on behalf of the principal. It also gives
the Attorney-in-Fact the right to make health care decisions in event of the principal's
incapacity. This document contains many of the powers typically included in a power of
attorney, but can be customized to contain the specific powers the principal wishes to grant
to his or her Attorney-in-Fact.
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DURABLE POWER OF ATTORNEY FOR CARE OF CHILDREN
KNOW ALL PERSONS BY THESE PRESENTS:
That pursuant to the Wisconsin 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)]
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; 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
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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____
Signature of principal
Signature of agent
Witness signature #1 : ________________________
Name : ________________________
Address : ________________________
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Witness signature #2 : ________________________
Name : ________________________
Address : ________________________
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State of Wisconsin
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].
My commission expires: _______________
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