Power Of Attorney Form For Care Of Minor Nj Page 2
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53.
T he
A ttorney-‐in-‐Fact
n amed
i n
p aragraph
t hree
( 3)
s hall
h ave
t he
f ollowing
powers
i n
r egard
t o
t he
h ealth,
e ducation
a nd
g eneral
w elfare
o f
t he
M inor
Child(ren)
n amed
i n
p aragraph
o ne
( 1),
t o
w it:
(a)
T o
a ct
f or
a nd
o n
b ehalf
o f
t he
u ndersigned
t o
c onsent
t o
a ny
x -‐ray
examination,
a nesthetic,
m edical
o r
s urgical
d iagnosis
o r
t reatment,
a nd
h ospital
care
w hich
i s
d eemed
a dvisable
b y,
a nd
i s
t o
b e
r endered
u nder
t he
g eneral
o r
specific
s upervision
o f
a ny
p hysician
a nd
s urgeon
l icensed
u nder
t he
p rovision
o f
the
M edical
P ractice
A ct,
w hether
s uch
d iagnosis
o r
t reatment
i s
r endered
a t
t he
office
o f
s aid
p hysician
o r
a t
a
h ospital,
d uring
a ll
t imes
t hat
t he
M inor
C hild(ren)
is/are
i n
t he
p resence
o f
s aid
A ttorney-‐in-‐Fact.
I t
i s
u nderstood
t hat
t his
p ower
i s
given
i n
a dvance
o f
a ny
s pecific
d iagnosis,
t reatment,
o r
h ospital
c are
b eing
required,
b ut
i s
g iven
t o
p rovide
a uthority
a nd
p ower
o n
t he
p art
o f
o ur
a foresaid
Attorney-‐in-‐Fact
t o
g ive
s pecific
c onsent
t o
a ny
a nd
a ll
s uch
d iagnosis,
t reatment,
o r
hospital
c are
w hich
t he
a forementioned
p hysician
i n
t he
e xercise
o f
h is
o r
h er
b est
judgment
m ay
d eem
a dvisable;
a nd
(b)
T o
d o
a nd
p erform
a ny
a nd
a ll
a cts
n ecessary
o r
r equired
t hat
a
n atural
parent
w ould
p erform
i n
r eference
t he
e ducation
o f
s aid
M inor
C hild(ren).
I t
i s
expressly
t he
i ntent
o f
t he
N atural
G uardian(s)
t hat
t he
A ttorney-‐in-‐Fact
i s
h ereby
given
w ide
d iscretion
i n
e ducation
m atters
a nd
t hat
a ll
e ducational
i nstitutions
s hall
recognize
a nd
f ollow
t he
i nstructions
o f
t he
A ttorney-‐in-‐Fact
i n
r egard
t o
t he
education
o f
s uch
C hild(ren);
a nd
(c)
T o
p erform
a nd
p rovide
d iscipline
t o
s aid
C hild(ren)
a s
i f
s aid
A ttorney-‐in-‐
fact
w ere
t he
N atural
G uardian
o f
s aid
M inor
C hild(ren);
a nd
(d)
T o
p erform
a nd
a ct
a s
N atural
p arent
i n
r eference
t o
a ny
a nd
a ll
l egal
m atters
necessary
o r
d esirable
f or
t he
c ustody,
c are
a nd
e ducation
o f
s aid
M inor
C hild(ren);
and
(e)
I
d o
a uthorize
m y/our
a foresaid
A ttorney-‐in-‐Fact
t o
e xecute,
a cknowledge
and
d eliver
a ny
i nstrument
u nder
s eal
o r
o therwise,
a nd
t o
d o
a ll
t hings
n ecessary
to
c arry
o ut
t he
i ntent
h ereof,
h ereby
g ranting
u nto
s aid
A ttorney-‐in-‐Fact
f ull
p ower
and
a uthority
t o
a ct
i n
a nd
c oncerning
t he
p remises
a s
f ully
a nd
e ffectually
a s
t he
Natural
P arent(s)
m ay
d o
i f
p ersonally
p resent,
l imited,
h owever,
t o
t he
p urpose
f or
which
t his
l imited
p ower
o f
a ttorney
i s
e xecuted.
T he
A ttorney-‐in-‐Fact
m ay
e xecute
any
a nd
a ll
s uch
d ocuments
o r
o ther
p apers
i n
t he
f ollowing
f orm:
“________________________
,
A ttorney-‐in-‐Fact
f or
{ name
a pplicable
C hild},
a
M inor
C hild”.
4.
T he
N atural
P arent(s)
h ereby
r elease
t he
A ttorney-‐in-‐Fact
f rom
a ny
a nd
a ll
liability
a nd
d amages
o f
a ny
k ind
o r
c haracter
w hatsoever
f or
t he
p erformance
o f
the
d uties
h erein
p rovided
i n
c onsideration
f or
t he
A ttorney-‐in-‐Fact’s
a cceptance
o f
the
d uties
s pecified
h erein.
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