Custody Power of Attorney
I, [Parent/Guardian's Full Name], residing at [Parent/Guardian's Address], hereby grant temporary custody of my child, [Child's Full Name], born on [Child's Date of Birth], to [Your Name], residing at [Your Company Address], effective from [Start Date] to [End Date].
I. Introduction
I, [Parent/Guardian's Full Name], am the legal parent/guardian of [Child's Full Name], born on [Child's Date of Birth], and I currently hold legal custody of the aforementioned child. Due to unavoidable circumstances, I will be required to travel for an extended period, and during my absence, I wish to ensure that my child receives appropriate care and guardianship.
II. APPOINTMENT OF ATTORNEY-IN-FACT
In consideration of the above circumstances, I hereby appoint [Your Name] as the attorney-in-fact or custodian for my child, [Child's Full Name]. [Your Name] is hereby authorized and empowered to act on my behalf in all matters related to the care, upbringing, education, and healthcare decisions for my child during the specified period of temporary custody.
III. RESPONSIBILITIES OF ATTORNEY-IN-FACT
During the period of temporary custody, [Your Name] shall have the following responsibilities:
Provide for the day-to-day care and welfare of my child, including but not limited to ensuring proper nutrition, clothing, shelter, and emotional support.
Make decisions regarding my child's education, including enrollment in educational institutions and participation in extracurricular activities.
Authorize medical treatment for my child in case of emergencies or as deemed necessary, including consent for surgeries, medications, and other medical procedures.
Ensure that my child maintains regular contact and visitation with me, to the extent feasible under the circumstances.
IV. LIMITATIONS OF AUTHORITY
This Custody Power of Attorney does not grant [Your Name] the authority to:
Consent to the adoption of my child.
Relocate my child's primary residence without my express written consent.
Terminate my parental rights or make permanent decisions regarding my child's custody without my consent.
V. REVOCATION OF POWER OF ATTORNEY
I reserve the right to revoke this Custody Power of Attorney at any time, by providing written notice to [Your Name] and any relevant parties involved in the care of my child.
IN WITNESS WHEREOF, I have executed this Custody Power of Attorney on [Date of Execution].
[Parent/Guardian's Full Name]
[Date]
[Your Name]
[Date]
_____________________________________________________________________________________
WITNESS ACKNOWLEDGEMENT
We, the undersigned witnesses, hereby acknowledge that the above-named Principal has signed this Power of Attorney in our presence on the date stated above.
Witness 1:
[Witness 1 full name]
[Date]
Witness 2:
[Witness 2 full name]
[Date]
_____________________________________________________________________________________
NOTARY ACKNOWLEDGEMENT
On this day of in the year , before me, a Notary Public in and for said County and State, personally appeared [Your Name], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.
Witness my hand and official seal.
[Notary Public's Name]
My Commission Expires:
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