Limited Power Of Attorney And Release (Page 2 of 3) in pdf

THIS DOCUMENT IS NOT INTENDED TO CONSTITUTE NOTICE REQUIRED UNDER FEDERAL AND STATE

LAWS AND REGULATIONS AND IS NOT A WAIVER OF ANY RIGHTS RELATING TO PRIVACY OF MEDICAL

INFORMATION OR UNDER (TO THE EXTENT APPLICABLE) THE STANDARDS FOR PRIVACY OF

INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION PUBLISHED BY THE U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES AT 45 C.F.R. PARTS 160 AND 164 UNDER THE HEALTH INSURANCE PORTABILITY

AND ACCOUNTABILITY ACT OF 1996 (“HIPAA”), AS AMENDED. ALL REQUIRED HIPAA AND OTHER

PRIVACY RIGHT NOTICES, IF ANY, ARE PROVIDED IN OTHER DOCUMENTS.

PARENTAL AUTHORITY

The Undersigned (whether legal parents and/or legal guardians of the Student), on each Parent’s own behalf and for

and on behalf of the above identified Student, each hereby represent and warrant to FAA as follows (check t he applicable

boxes below):

_______ IF PARENT: Parent is the natural living parent or parents of the above identified Student who is a minor, with

full rights and authority to sign all documents on behalf of the Student both under the laws of the state o f Florida

and the state, territory or country in Ih the Student and each Parent are residents and citizens. Additionally, each

undersigned Parent represents and warrants to FAA that he or she has the legal right without restriction, Iing any

restriction imposed by a settlement agreement, dissolution of marriage judgment or order, and order establishing a

guardianship over the Student, to sign all documents on behalf of the Student Ih requires the consent of both

parents and/or legal guardians. The undersigned Parent has not had his or her legal parental or guardianship rights

terminated by any lawful authority Iing a court of law. It shall be the duty of each undersigned Parent to advise

FAA, in writing, of any change to the representations and legal status of such Parent or Guardian after this

document is signed.

_______ IF LEGAL GUARDIAN: Parent is the legal guardian of the above identified Student who is a minor, with full

rights and authority to sign all documents on behalf of the Student both under the laws of the state of Florida and

the state, territory or country in Ih the Student and the undersigned Parent is a resident and citizen (please submit

all documents establishing legal guardianship).

_______ ALL PARTIES TO CHECK: Each Parent, if more than one individual, hereby appoint each other as his or her

attorney-in-fact and to act in his or her stead, with full power and authority with respect to all matters, without the

necessity of obtaining each other’s consent, Iing signing any and all documents, consents, authorizations and

releases concerning the Student’s enrollment, medical treatment, activities, health, residence, classes and welfare,

while enrolled in or in residence at FAA. Each Parent hereby affirms that all acts done by the designated a ttorney-

in-fact pursuant to this Parental POA shall bind each Parent, his or her heirs, devisees and personal

representatives. Further, each Parent hereby confirms all acts of his or her attorney -in-fact, pursuant to this

Parental POA.

THE REPRESENTATIONS CONTAINED IN THIS DOCUMENT SHALL APPLY TO ALL DOCUMENTS SIGNED BY

THE PARENTS FOR THEMSELVES AND ON BEHALF OF THE STUDENT, IING THOSE SIGNED PRIOR TO AND

AFTER THE DATE HEREOF. THIS PARENTAL POA AND ALL POWERS CONFERRED HEREIN SHALL REMAIN

IN FULL FORCE AND EFFECT DURING ALL TIMES IN IH THE STUDENT IS ENROLLED OR IN RESIDENCE AT

FAA, AND ALL REPRESENTATIONS PROVIDED HEREIN SHALL SURVIVE TERMINATION OF THE STUDENT’S

ENROLLMENT.

[Signatures and Notary Acknowledgements to Follow]

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