Durable Power of Attorney
For Care of Children
ocstoc Legal Agreements
This Durable Power Of Attorney for Care Of Children is intended to provide
for the appointment of an Attorney-in-Fact for the purposes of taking care
of children and making decisions regarding their education and medical
care.
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Attorney Drafted
DURABLE POWER OF ATTORNEY FOR CARE OF CHILDREN
KNOW ALL PERSONS BY THESE PRESENTS:
That pursuant to § 58.625 of the 2010 Kansas 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 children, their education including attending
conferences with their teachers or any other educational authorities, granting
permission for their participation in school trips and other activities, and making any
other decisions and executing any documents pertinent to 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.
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c. To grant permission and consent to my children 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 children, including making decisions
regarding 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
children and to examine their medical records and to consent to the disclosure of such
records in circumstances the 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 children 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 which 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
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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: The 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 the Attorney-in-Fact named herein.
IN WITNESS WHEREOF, I hereunto set our hands and seals on ____ [Month] ____ [Date],
20____ [Year]
_______________________
Signature of principal Witness signature #1 : ________________________
Name : ________________________
Address : ________________________
Witness signature #2 : ________________________
Name : ________________________
Address : ________________________
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ACKNOWLEDGEMENT
State of Kansas
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)
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