Wyoming Durable Power Of Attorney for Care Of Children


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                             This Durable Power Of Attorney for Care of Children is used by individuals located in
                             Wyoming 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.

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That pursuant to the Wyoming 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;

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           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

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

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                                       Witness signature #1 :         ________________________

                                       Name                   :       ________________________

                                       Address                :       ________________________

                                       Witness signature #2 :         ________________________

                                       Name                   :       ________________________

                                       Address                :       ________________________

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State of Wyoming

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], ____


                                                       Notary Public

                                                       My commission expires: _______________


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