Parent Or Legal Guardian Power Of Attorney Delegating Parental Authority To Non-Parent printable pdf download

Parent Or Legal Guardian Power Of Attorney Delegating Parental Authority To Non-Parent

PARENT OR LEGAL GUARDIAN

POWER OF ATTORNEY

DELEGATING PARENTAL AUTHORITY TO NON-PARENT

In accordance with the provisions of ORS 109.056, the undersigned parent (or legal guardian) of said minor child,

, Birth Date:

(mm/dd/yy), Grade:

HEREBY APPOINTS:

(Recipient of Power of Attorney)

(Relationship, if Applicable)

(Street Address)

(City, State, Zip)

(Day Phone)

(Home Phone)

As my true and lawful attorney with the power to act for the parent or legal guardian, and to exercise parental

authority and control regarding the care, custody, or property of said student, except the power to consent to

marriage or adoption. Said minor child is residing on a permanent full-time basis with the appointed attorney-in-fact

at the address set forth above.

The undersigned affirms that the granting of this Power of Attorney is not for the primary purpose of said student(s)

to attend in a specific school district, nor is it to circumvent Board policy set forth for inter-district transfers. It is

understood that this may constitute theft of services and, as the parent; I may be responsible for payment of the

appropriate nonresident student tuition under ORS 164.125. Pursuant to Oregon Law, this Power of Attorney

automatically terminates six (6) months from the date hereof, unless revoked in writing prior thereto by the parent,

guardian, or the attorney-in-fact. Any Revocation to the Power of Attorney must be signed by the party in the

presence of a Notary Public and delivered to the student’s school principal.

PARENT OR LEGAL GUARDIAN:

(Print Name)

(Address)

(Phone)

DATED THIS

DAY OF

PARENT OR LEGAL GUARDIAN SIGNATURE

STATE OF OREGON

County of

SUBSCRIBED AND SWORN/AFFIRMED to, before me this

day of

Notary Public of Oregon

Recipient of Power of Attorney (Attorney-In-Fact) must sign consent on reverse side (in

presence of a Notary Public).

Parent Or Legal Guardian Power Of Attorney Delegating Parental Authority To Non-Parent