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SAMPLE DESIGNATION OF GUARDIANS AND DURABLE POWER OF
ATTORNEY
Whereas, [list name of first
parent] and [list name of second
parent], are the parent and natural guardians of the following
child(ren):
[list child(rens) names]
I designate [list name of guardian] of
[city, state of guardian's residence] to act
as guardian of the minor child(ren) stated above upon my incapacity to so act.
Should [list name of guardian] be unable or
unwilling to serve, I designate [list alternate
guardian] of [city, state of alternate
guardian] to act as the guardian of the minor children in the place
of [list name of guardian].
Upon my disability, the designated guardian shall have the following
authority:
a) residential custody of the minor child(ren);
b) to designate
schooling for the minor children, and access to any and all of their
educational records;
c) to approve medical treatment of any kind or type
or to disapprove the same within the bounds of the law;
d) to generally
act in loco parentis.
In the event that formal legal proceedings are commenced to establish a
guardian for the child, it is my desire that the guardians mentioned herein have
priority in appointment.
In the event that I am the custodian of any property for the minor children
under the Uniform Transfer to Minor's Act, or the Uniform Gifts to Minors Act or
similar statute, I designate the guardian or successor guardian to act as
custodian for all such custodial property.
The failure to list an individual as a guardian or successor guardian is
intentional.
Dated: __________________________
________________________________________________________________
Principal(s)
STATE OF [state where designation
signed]
COUNTY OF [country where
designation signed]
Before me, the undersigned authority personally appeared the above signatory
(signatories) who acknowledged to me execution of this durable power of
attorney.
___________________________________________________________
