Georgia Power Of Attorney For The Care Of A Minor Child (Page 3 of 5) in pdf

Georgia Power Of Attorney For The Care Of A Minor Child Page 3

(5) (Optional) If a guardian of my minor child is to be appointed, I nominate the

following person to serve as such guardian: _________________________________

(insert name and address of person nominated to be guardian of the minor child).

(6) I am fully informed as to all of the contents of this form and I understand the full

import of this grant of powers to the agent grandparent.

(7) I certify that the minor child is not emancipated, and, if the minor child becomes

emancipated, this power of attorney shall no longer be valid.

(8) Except as may be permitted by the federal No Child Left Behind Act, 20 U.S.C.A.

Section 6301, et seq. And Section 7801, et seq., I hereby certify that this power of

is not executed for the primary purpose of unlawfully enrolling the child in a school so

that the child may participate in the academic or interscholastic athletic programs

provided by that school.

(9) I certify that, to my knowledge, the minor child’s welfare is not the subject of an

investigation by the Department of Human Resources.

(10) I declare under penalty of perjury under the laws of the State of Georgia that the

foregoing is true and correct.

Parent Signature: ______________________________________________________

Printed Name: ________________________________________________________

Parent Signature: ______________________________________________________

Printed Name: ________________________________________________________

Signed and sealed in the presence of: ______________________________________

Notary public

My commission expires ______________________

ADDITIONAL INFORMATION:

To the grandparent designated as attorney in fact:

(1) If a change in circumstances results in the child not living with you for more

than six weeks during a school term and such change is not due to hospitalization,

vacation, study abroad, or some reason otherwise acceptable to the school, you

Georgia Power Of Attorney For The Care Of A Minor Child Page 3