POWER OF ATTORNEY DELEGATING PARENTAL POWERS

[PARENT’S NAME], a parent or guardian of the minor child/ren:

[CHILD’S NAME], born [MM/DD/YYYY]
[CHILD’S NAME], born [MM/DD/YYYY]
[CHILD’S NAME], born [MM/DD/YYYY]

pursuant to Idaho Code Section 15-5-104, delegates his/her/their parental powers to [DELEGATE’S NAME], of [DELEGATE’S ADDRESS].

☐ – The delegate named above is a ☐ grandparent, ☐ sibling of a parent, or ☐ sibling of the above minor child/ren. This power of attorney shall remain in full force and effect for ☐ three (3) years, unless earlier revoked by me in writing; OR ☐ from [MM/DD/YYYY] until [MM/DD/YYYY] unless earlier revoked by me in writing.

☐ – The delegate named above is NOT a grandparent, sibling of a parent, or sibling of the above minor child/ren. This power of attorney shall remain in full force and effect for six (6) months unless earlier revoked by me in writing.

This delegation includes all powers regarding the care, custody, and property of the minor child/ren except the power to consent to marriage or adoption of the minor child/ren.

This delegation expressly allows my delegate to travel outside the United States with the minor child/ren. ☐ Yes ☐ No

This delegation is effective ☐ immediately ☐ on the following date [MM/DD/YYYY].

Parent/Guardian Signature: _______________ Date: _______
Print Name: _______________

Parent/Guardian Signature: _______________ Date: _______
Print Name: _______________

NOTARY ACKNOWLEDGMENT

State of Idaho
County of _______________, ss.

On the ___ day of _______________, 20___, before me, a Notary Public, personally appeared _______________, known or identified to me to be the person whose name is subscribed to the within or foregoing instrument, and acknowledged to me that s/he executed the same. WITNESS my hand and seal the day and year as previously stated.

Notary Signature: _______________
Notary for: _______________
Residing at: _______________
Commission expires: _______________