Fillable Delegation Of Power By Parent Or Guardian Form printable pdf download

Delegation Of Power By Parent Or Guardian Form

Download a blank fillable Delegation Of Power By Parent Or Guardian Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Delegation Of Power By Parent Or Guardian Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

DELEGATION OF POWER BY PARENT OR GUARDIAN

PURSUANT TO §15-14-105, C.R.S

I, __________________________________________

(full name), parent or guardian of the

minor child(ren) or incapacitated person(s) named below:

Full

Name

Child

Date of Birth

Relationship

Incapacitated Person

I hereby authorize and appoint __________________________________

(name of person), as

Attorney in Fact for me with full authority to act in my place as follows:

1. To perform any and all acts necessary for the day-to-day care, custody, education,

recreation, and property of the above-named minor child or incapacitated person,

consistent with the provision of §15-14-105, C.R.S.

2. To authorize any and all medical and dental care for the health and well being of the

minor child(ren) or incapacitated person(s). This care includes, but is not limited to

medical and dental exams and tests, x-rays, surgeries, anesthesia, and hospital care.

This Special Power of Attorney does not give the Attorney in Fact the power to consent to the

marriage or adoption of the child or incapacitated person.

This Special Power of Attorney shall be effective until ____________________

unless revoked

earlier by the parent or guardian in writing. In any case, the authority granted herein shall not

be valid for more than 12 months from the date of this document.

Date: _______________________

_________________________________________

Parent/Guardian Signature

Subscribed and affirmed, or sworn to before me in the County of _____________________________

State of

________________

, this

___________

day of

_______________

, 20

______

My Commission Expires: ______________

____

__________________________________

Notary Public/Clerk

JDF 751 3/08 DELEGATION OF POWER BY PARENT OR GUARDIAN PURSUANT TO §15-14-105, C.R.S.

Delegation Of Power By Parent Or Guardian Form

Related Articles

Related forms

Related Categories