DURABLE POWER OF ATTORNEY
DELEGATING PARENTAL AUTHORITY 
(With Consent for Medical Care)



BE IT KNOWN, that ______________________________________ and 

____________________________________, of _______________________, NY. 
the undersigned parents and the lawful guardian (Grantors) of 

___________________________ do here-by Grant ________________________ 

of ___________________________ , ________.here after known as 
Custodian of 

_____________________________ here in after known as said child with 
the following powers, authorities and consents to wit:

Grantors consents to the temporary custody of said child by the 
custodian for the period and purpose as follows:
1) To commence On ______/_______, 2002 till other wise rescinded


Grantors Authorized the Custodian to do and undertake all acts as are 
reasonable and necessary to protect the best interests and welfare of 
said child while under the care of the Custodian. Without limiting 
the generality of the foregoing, the Custodian is further authorized 
to provide emergency and general medical care which the Custodian in 
their discretion deems necessary or advisable for any illness or 
injury sustained by said child during this temporary custody.

Grantors consents to any reasonable discipline imposed upon said 
child by the guardian provided that said discipline dose not 
constitute unreasonable abuse.

Grantors agrees to exonerate and hold harmless the Custodian and 
their relatives from any loss or liability arising during this 
custody, excepting for any acts of ordinary negligence or wanton, 
willful or reckless conduct. Grantors specifically agree to reimburse 
the Custodian for any reasonable expenditure required for proper care 
for said child.






________________________________                Date: _____/______/ 
2002
       Grantor Signature Father


________________________________                Date: _____/______/ 
2002
                    Grantor Signature Mother


STATE OF                }  NEW YORK

COUNTY OF            }  __________________________


On _____/______/ 2002 before 
me,________________________________ ,personally 

appeared ________________________________ and 
________________________________, personally known to me (or proved 
to me on the basis of satisfactory evidence) to be the persons whose 
names is in their authorized capacities, and that by their signatures 
on this instrument the persons, or the entity upon behalf of which 
the persons acted, executed this instrument. I WITNESS my hand and 
official seal


Signature ____________________________.



Grantors:  ______ Known     _______ Unknown
                                                                     
                                                                   ID 
Produced ___________________________
                                                                   
                                                                      
                               ID Produced 
___________________________                                           
                                                                      
                                                                      



(Seal)