Power Of Attorney For Minors

_________________________

(Date)

TO WHOM IT MAY CONCERN:

I, _____________________________, father/mother of __________________________,

(parent name)

(student name)

give legal authority to make any educational or medical decisions for

___________________________ in my absence to ______________________________.

(student name)

(guardian’s name)

__________________________________

__________________

(parent signature in front of notary)

(date)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

NOTARY ACKNOWLEDGEMENT

STATE OF NEBRASKA

COUNTY OF _________________

This person(s) was acknowledged before me on this ____ day of _______________,

200___.

___________________________

Notary Seal:

Notary Official

Commission expires _________________

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Parent category: Legal