Special Power Of Attorney printable pdf download

4080 Roselea Place, Columbus, Ohio 43214, 614-267-2502; Fax: 614-267-1677;

SPECIAL POWER OF ATTORNEY

For use by the member schools of the Ohio High School Athletic Association

Bylaw 4-6-3, ex. 7 – Parents out of state

THIS IS A MILITARY POWER OF ATTORNEY PREPARED AND EXECUTED PURSUANT TO TITLE 10, UNITED STATES CODE, SECTION 1044B, BY A

PERSON AUTHORIZED TO RECEIVE LEGAL ASSISTANCE FROM THE MILITARY SERVICES. FEDERAL LAW EXEMPTS A MILITARY POWER OF

ATTORNEY FROM ANY REQUIREMENT OF FORM, SUBSTANCE, FORMALITY OR RECORDING THAT IS PROVIDED FOR POWERS OF ATTORNEY BY

THE LAW OF ANY STATE, COMMONWEALTH, TERRITORY, DISTRICT, OR POSSESSION OF THE UNITED STATES. FEDERAL LAW SPECIFIES THAT A

MILITARY POWER OF ATTORNEY SHALL BE GIVEN THE SAME LEGAL EFFECT AS A POWER OF ATTORNEY PREPARED AND EXECUTED IN

ACCORDANCE WITH THE LAWS OF THE JURISDICTION WHERE IT IS PRESENTED.

KNOW ALL PERSONS, that I, __________________________________, a legal resident of _________ and presently residing

at _____________________________________________________, ______ desiring to execute a SPECIAL POWER OF

ATTORNEY, do hereby appoint_________________________ ________________my _____________ whose address is

____________________________, OHIO, _______, as my Attorney-in-Fact to act as follows, GRANTING unto my said Attorney

full power to:

Take temporary custody of my children and maintain and care for my children in my absence for any reason and exercise all

legal rights in connection with the maintenance and care of said children, to the same extent as I could until such time as I can

return and resume my normal parental duties. Also, authorize and execute consent for any and all medical and hospital care

and treatment, including major surgery, deemed necessary by a duly licensed physician selected by my Attorney-in-Fact for the

health and well-being of my children. This power applies to the following children:

Name of Student

Date of Birth

High School Attending

___________________

__________

_____________________

__________

_____________________

__________________

TERMINATION: This Power of Attorney shall become null and void the ____day of ____, 201__ unless I should become

incapacitated; in that case, it shall remain in effect until revoked by me.

Notwithstanding my insertion of a specific expiration date herein, if on the above specified expiration date I shall be, or have

been, carried in a military status of "missing," "missing-in-action," or "prisoner of war," then this power of attorney shall

automatically remain valid and in full effect until sixty(60) days after I have returned to United States Military control following

termination of such status.

IN WITNESS WHEREOF, I have hereunto set my hand this the ______ day of _______, 201___.

__________________________________________

PARENT’S NAME

With the Armed Forces at ________________________________________________________________, USA

On this ____day of ____ 201__, I, an officer, authorized the general powers of a Notary Public under the provisions of Title 10,

United States Code, Section 1044a, certify that the person whose name is signed to this instrument is within the class defined by

Title 10, United States Code, Section 1044, did personally appear before me and, after the contents of this instrument had been

read and explained, did sign this instrument and acknowledge doing so freely and voluntarily for the uses, purposes, and

considerations set forth above.

____________________________________________________________________________________

NOTARY PUBLIC’S NAME, RANK, MILITARY BRANCH

C:Users striedAppDataLocalMicrosoftWindowsTemporary Internet FilesContent.OutlookQK65LX54Bylaw 4-6-3 - Exception seven form - Special Military

POA - 2016-2017.rtf

Special Power Of Attorney

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