§ 19-9-129 - Power of attorney form
O.C.G.A. 19-9-129 (2010)
19-9-129. Power of attorney form
(a) The statutory power of attorney for the care of a minor child form contained in this Code section may be used to grant an agent grandparent powers over the minor child's enrollment in school, medical, dental, and mental health care, food, lodging, recreation, travel, and any additional powers as specified by the parent. This power of attorney is not intended to be exclusive. No provision of this article shall be construed to bar use by the parent of any other or different form of power of attorney for the care of a minor child which complies with this article. A power of attorney for the care of a minor child in substantially the form set forth in this Code section shall have the same meaning and effect as prescribed in this article. Substantially similar forms may include forms from other states.
(b) The power of attorney for the care of a minor child shall be in substantially the following form:
"GEORGIA POWER OF ATTORNEY FOR THE CARE OF A MINOR CHILD
NOTICE:
(1) THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE GRANDPARENT THAT
YOU DESIGNATE (THE AGENT GRANDPARENT) POWERS TO CARE FOR YOUR MINOR CHILD,
INCLUDING THE POWER TO: ENROLL THE CHILD IN SCHOOL AND IN EXTRACURRICULAR
SCHOOL ACTIVITIES; HAVE ACCESS TO SCHOOL RECORDS AND DISCLOSE THE CONTENTS
TO OTHERS; ARRANGE FOR AND CONSENT TO MEDICAL, DENTAL, AND MENTAL HEALTH
TREATMENT FOR THE CHILD; HAVE ACCESS TO SUCH RECORDS RELATED TO TREATMENT
OF THE CHILD AND DISCLOSE THE CONTENTS OF THOSE RECORDS TO OTHERS; PROVIDE
FOR THE CHILD'S FOOD, LODGING, RECREATION, AND TRAVEL; AND HAVE ANY
ADDITIONAL POWERS AS SPECIFIED BY THE PARENT.
(2) THE AGENT GRANDPARENT IS REQUIRED TO EXERCISE DUE CARE TO ACT IN THE
CHILD'S BEST INTEREST AND IN ACCORDANCE WITH THE GRANT OF AUTHORITY
SPECIFIED IN THIS FORM.
(3) A COURT OF COMPETENT JURISDICTION MAY REVOKE THE POWERS OF THE AGENT
GRANDPARENT IF IT FINDS THAT THE AGENT GRANDPARENT IS NOT ACTING PROPERLY.
(4) THE AGENT GRANDPARENT MAY EXERCISE THE POWERS GIVEN IN THIS POWER OF
ATTORNEY FOR THE CARE OF A MINOR CHILD THROUGHOUT THE CHILD'S MINORITY
UNLESS THE PARENT REVOKES THIS POWER OF ATTORNEY AND PROVIDES NOTICE OF THE
REVOCATION TO THE AGENT GRANDPARENT OR UNTIL A COURT OF COMPETENT
JURISDICTION TERMINATES THIS POWER.
(5) THE AGENT GRANDPARENT MAY RESIGN AS AGENT AND MUST IMMEDIATELY
COMMUNICATE SUCH RESIGNATION TO THE PARENT, AND IF COMMUNICATION WITH SUCH
PARENT IS NOT POSSIBLE, THE AGENT GRANDPARENT SHALL NOTIFY CHILD PROTECTIVE
SERVICES OR SUCH GOVERNMENT AUTHORITY THAT IS CHARGED WITH ASSURING PROPER
CARE OF SUCH MINOR CHILD.
(6) THIS POWER OF ATTORNEY MAY BE REVOKED IN WRITING BY ANY AUTHORIZING
PARENT. IF THE POWER OF ATTORNEY IS REVOKED, THE REVOKING PARENT SHALL
NOTIFY THE AGENT GRANDPARENT, SCHOOL, HEALTH CARE PROVIDERS, AND OTHERS
KNOWN TO THE PARENT TO HAVE RELIED UPON SUCH POWER OF ATTORNEY.
(7) IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU
SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.
POWER OF ATTORNEY FOR THE CARE OF A MINOR CHILD
made this day of , .
(1) (A) I, (insert name and address of parent or
parents), hereby appoint (insert name and address of grandparent to
be named as agent) as attorney in fact (the agent grandparent) for my child
(insert name of child) to act for me and in my name in any way that
I could act in person.
(B) I hereby certify that the agent grandparent named herein is the
(place a check mark beside the appropriate description):
Biological grandparent;
Stepgrandparent;
Biological great-grandparent; or
Stepgreat-grandparent.
(2) The agent grandparent may:
(A) Enroll the child in school and in extracurricular activities,
have access to school records, and may disclose the contents to others;
(B) Arrange for and consent to medical, dental, and mental health
treatment of the child, have access to such records related to treatment of
the child, and disclose the contents of such records to others;
(C) Provide for the child's food, lodging, recreation, and travel; and
(D) Carry out any additional powers specified by the parent as
follows:
(3) The powers granted above shall not include the following powers or
shall be subject to the following rules or limitations (here you may include
any specific limitations that you deem appropriate):
(4) This power of attorney for the care of a minor child is being
executed because of the following hardship (initial all that apply):
(A) The death, serious illness, or terminal illness of a parent;
(B) The physical or mental condition of the parent or the child
such that proper care and supervision of the child cannot be provided by the
parent;
(C) The loss or uninhabitability of the child's home as the result
of a natural disaster;
(D) The incarceration of a parent; or
(E) A period of active military duty of a parent.
(5) (Optional) If a guardian of my minor child is to be appointed, I
nominate the following person to serve as such guardian:
(insert name and address of person nominated to be guardian of the minor child).
(6) I am fully informed as to all of the contents of this form and I
understand the full import of this grant of powers to the agent grandparent.
(7) I certify that the minor child is not emancipated, and, if the minor
child becomes emancipated, this power of attorney shall no longer be valid.
(8) Except as may be permitted by the federal No Child Left Behind Act,
20 U.S.C.A. Section 6301, et seq., and Section 7801, et seq., I hereby certify
that this power of attorney is not executed for the primary purpose of
unlawfully enrolling the child in a school so that the child may participate
in the academic or interscholastic athletic programs provided by that school.
(9) I certify that, to my knowledge, the minor child's welfare is not
the subject of an investigation by the Department of Human Services.
(10) I declare under penalty of perjury under the laws of the State of
Georgia that the foregoing is true and correct.
Parent Signature:
Printed name:
Parent Signature:
Printed name:
Signed and sealed in the presence of:
Notary public
My commission expires
"
(c) The following notice shall be attached to the power of attorney:
"ADDITIONAL INFORMATION:
To the grandparent designated as attorney in fact:
(1) If a change in circumstances results in the child not living with
you for more than six weeks during a school term and such change is not due to
hospitalization, vacation, study abroad, or some reason otherwise acceptable
to the school, you should notify in writing the school in which you have
enrolled the child and to which you have given this power of attorney form.
(2) You have the authority to act on behalf of the minor child until
each parent who executed the power of attorney for the care of the minor child
revokes the power of attorney in writing and provides notice of revocation to
you as provided in O.C.G.A. Section 19-9-128.
(3) If you are made aware of the death of the parent who executed the
power of attorney, you must notify the surviving parent as soon as
practicable. With the consent of the surviving parent, or if the whereabouts
of the surviving parent are unknown, the power of attorney may continue for up
to six months so that the child may receive consistent care until more
permanent custody arrangements are made.
(4) You may resign as agent by notifying each parent in writing by
certified mail or statutory overnight delivery, return receipt requested, and
if you become unable to care for the child, you shall cause such resignation
to be communicated to the parent. If communication with such parent is not
possible, you must notify child protective services or such government
authority that is charged with assuring proper care of such minor child.
To school officials:
(1) Except as provided in the policies and regulations of the county
school board and the federal No Child Left Behind Act, 20 U.S.C.A. Section
6301, et seq., and Section 7801, et seq., this power of attorney, properly
completed and notarized, authorizes the agent grandparent named herein to
enroll the child named herein in school in the district in which the agent
grandparent resides. That agent grandparent is authorized to provide consent
in all school related matters and to obtain from the school district
educational and behavioral information about the child. Furthermore, this
power of attorney shall not prohibit the parent of the child from having
access to all school records pertinent to the child.
(2) The school district may require such residency documentation as is
customary in that school district.
(3) No school official who acts in good faith reliance on a power of
attorney for the care of a minor child shall be subject to criminal or civil
liability or professional disciplinary action for such reliance.
To health care providers:
(1) No health care provider who acts in good faith reliance on a power
of attorney for the care of a minor child shall be subject to criminal or
civil liability or professional disciplinary action for such reliance.
(2) The parent continues to have the right to all medical, dental, and
mental health records pertaining to the minor child."