Georgia Power Of Attorney For The Care Of A Minor Child (Page 2 of 5) in pdf

Georgia Power Of Attorney For The Care Of A Minor Child Page 2

made this _________ day of __________, ___.

(1)(A) I, ______________________ (insert name and address of parent or parents),

hereby appoint _____________________________________________ (insert name

and address of grandparent to be named as agent) as attorney in fact (the agent

grandparent) for my child _________________________________________(insert

name of child) to act for me and in my name in any way that I could act in person.

(B) I hereby certify that the agent grandparent named herein is the (place a check mark

beside the appropriate description):

_____ Biological grandparent;

_____ Stepgrandparent;

_____ Biological great-grandparent; or

_____ Stepgreat-grandparent.

(2) The agent grandparent may:

(A) Enroll the child in school and in extracurricular activities, have access to school

records, and may disclose the contents to others;

(B) Arrange for and consent to medical, dental, and mental health treatment of the

child, have access to such records related to treatment of the child, and disclose

the contents of such records to others;

(D) Carry out any additional powers specified by the parent as follows:

_________________________________________________________________

(3) The powers granted above shall not include the following powers or shall be subject

to the following rules or limitations (here you may include any specific limitations

that you deem appropriate):

____________________________________________________________________

(4) This power of attorney for the care of a minor child is being executed because of the

following hardship (initial all that apply):

_____ (A) The death, serious illness, or terminal illness of a parent;

_____ (B) The physical or mental condition of the parent or the child such that proper

and supervision of the child cannot be provided by the parent;

_____ (C) The loss or uninhabitability of the child’s home as the result of a natural

disaster;

_____ (D) The incarceration of a parent; or

_____ (E) A period of active military duty of a parent.

Georgia Power Of Attorney For The Care Of A Minor Child Page 2