This Power of Attorney is a form which provides the appointment of an attorney-in-fact for the care of a child or children, including health care. This Power of Attorney form requires the signature of the person giving another the power of attorney to be notarized.

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POWER OF ATTORNEY: CARE AND CUSTODY OF CHILD OR CHILDREN KNOW ALL MEN BY THESE PRESENTS: That the undersigned, parent(s) of the child(men) identified below, residing at hereby make, constitute and
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