Fill and Sign the Appoint If More Than One Attorney in Fact is Appointed Add Jointlyquot Form

POWER OF ATTORNEY: CARE AND CUSTODY OF CHILD OR CHILDREN KNOW ALL MEN BY THESE PRESENTS: That the undersigned,__________________________________________, parent(s) of the child(ren) identified below,residing at _____________________________________________ hereby make, constitute andappoint ____________________________ (if more than one attorney-in-fact is appointed, add 'Jointly," "either of them" or "any one of them" to indicate how they must act) as the true and lawful Attorney(s)-in- Fact of the undersigned, to act in name, place and stead of the undersigned, to do and executeall or any of the following acts, deeds and things with respect to the care and custody of thefollowing child(ren):__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (a) To participate in decisions regarding the child(ren)’s education including attending conferences with the child(ren)’s teachers or any other educational authorities, grantingpermission for the child(ren)’s participation in school trips and other activities, and makingany other decisions and executing any documents pertinent to their education. (b) To grant permission and consent to the child(ren) participating in any activity sponsored by any group, association or organization which activity the Attorney(s)-in-Fact may deemappropriate. (c) To make health care decisions on behalf of the child(ren), including making decisions regarding the child(ren)’s medical or dental care, whether routine or emergency in nature,including admissions to hospitals or other institutions; to consent to, to refuse to consent to,or to withdraw consent to the provision of any care, tests, treatment, surgery, service orprocedure to maintain, diagnose or treat a physical or mental condition, as well as the right tosign such medical forms as may be necessary to carry out such decisions; to talk with health
 (or other professionals) and to be informed of the rights, rights † of others and the options. (d) to provide guidance and mentorship in meeting the needs and objectives(s) of the child(men), including guidance and mentorship with respect to family planning and reproductive matters including birth control, abortion, contraception, sterilization procedures and assisted reproduction procedures. (e) to make and carry out the decisions and actions with respect to the child for which the child’s parents have delegated their power to the attorney(s)-in- fact; and to do so, with a view to promoting the health, safety, development of the child and education of the child(men), and to provide them with care to which the parents are incompetent or incapable. (f) to perform medical and surgical services to the child(men), including, but not limited to: (i) providing treatment or procedures necessary to preserve their health; (ii) performing operations necessary to prevent or alleviate illness such as surgery, administration of medications or removal of bone or flesh. (g) to make educational decisions as may be appropriate, including attendance at conferences and workshops, granting permission for the children to attend schools and other educational facilities and programs; allowing the children to participate in activities in which their involvement as student, teachers, staff or volunteers, together with the child(men)’s other parents † , would promote the child's learning and development, their ability to participate fully in community life and contribute fully in civic, national and cultural activities, such as participation in parades, fairs, festivals and similar social-cultural events. (h) to have sole and exclusive custody of or visitation rights with the child, as may be requested or required by the child, the court, the other parent(s), or the child(men)’; if more than one child who resides at the same premises resides in the same household, consent of all parents who participate in or consent to the decisions for which an attorney(s)-in-fact is appointed or appointed with other parents † in support of the chilmenen) must be obtained. (i) to have custody of and visitation rights with any child or children not included in the person(s) or joint personal and household authority(s) of the other parent(s) or, if there are none, in the home of any grandparent or other parent or guardian designated by both parents, and to obtain the consent of these other parent(