General Power Of Attorney For Care And Custody Of Child (Arizona) {POA-AZ 102}

POWER OF ATTORNEY OVER A MINOR CHILD - HEALTH CARE NOTE: A parent or guardian of a minor or incapacitated person, by properly executed power of attorney, may delegate to another person, for a period not exceeding six months, any powers he may have regarding care, custody or property of the minor child or ward, except power to consent to marriage or adoption of the minor. (Arizona Revised Statutes Section 14-5104) Pursuant to, the above mentioned statute: I authorize of assume power of attorney over my minor children. STATE OF ARIZONA County of I, ) ) ss ) (parent's name) of: do solemnly swear that: (Parent's address) 1. I am the natural parent of: Name of Child(ren) Date of Birth to 2. I further appoint as my lawful and truth attorney-in-fact, for me and in my name, place and stead, for the purpose of consent or refusing consent to any medical treatment, including hospital admission, medical or surgical diagnosis and treatment, x-ray examination, anesthetic, or other related health care needs; to obtain medical and dental treatment, whether an emergency or not, and to consent and give permission for any operations, treatment or health care. Such attorney-in-fact is authorized to sign any and all forms required by health care agencies to indicate parental permission on behalf of each child. 4. The Power of Attorney herein granted undersigned shall be exercisable at any time from time to time begins from and expire on (6 months max) Until, I revoke it earlier. 5. I have given this consent of my own free will. 6. A photocopy or other reproduction of this power of attorney may be relied upon to the same extent as a signed original. Witness signature Signature of parent/guardian granting Power of attorney SUBSCRIBED and SWORN to before to on this date: Notary Public My Commission Expires: American LegalNet, Inc. © www.FormsWorkFlow.com