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Tennessee Guardian of Minor Power of Attorney Form

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Tennessee Guardian of Minor Power of Attorney Form is a limited legal document utilized by the parent(s) or guardian(s) only to be used upon an event that is specified: for example, an extended hospital stay, serious illness, temporary loss of employment, etc. Unlike most states, this document will not necessarily allow educational enrollment and may limit other powers. A school district or physician may or may not accept this document as power, other documentation may be required. This document must be type or printed and may be revoked at any time.

Laws – § 34-6-301 to § 34-6-310

How to Write

1 – Obtain A Copy Of This Power Appointment Form To Deliver Guardian/Caregiver Powers Over A Minor

The file available on this page through the buttons under the preview picture of the template will supply the structure and language necessary to apply Principal Powers over a minor to a Caregiver. Only the Minor’s Parents or Court Appointed Guardian can issue such Powers. Download a copy of this form, fill it out, then present it to the Parent/Court Appointed Guardian and Caregiver (Attorney-in-Fact or Agent) so they may provide some required acknowledgments and approvals.

2 – Produce A Clear Report On The Identity And Status Of Each Party Involved

This document will present several numbered areas where the information, acknowledgments, and approvals required to grant a Caregiver Principal Powers over a Minor or Child can be presented in a defined structure. TO begin, we must record the Full Name of the Child or Minor we are concerned with on the line labeled “1. Minor Child’s Name.”  The next items will be labeled “2. Mother/Legal Guardian’s Name & Address” and “3. Father/Legal Guardian’s Name & Address.” Utilize the blank lines supplied in each of these items to record the Name of the individual currently charged with the Child’s Welfare. Thus, enter the Mother, Father, and/or Current Guardian’s Full Name(s) and Complete Address(es) in these items.In the fourth item (“4. Caregiver’s Name & Address”), the Legal Name and Complete Residential Address of the intended Caregiver should be documented. This is the individual who will be granted the Principal Power and Responsibility in taking care of the Child/Minor.In the fifth item, a choice of statements has been presented so the status of the Child/Minor’s Parents’ Status. If both Parents are alive and will supply their Signatures to this document then, place an “X” or a check mark in the first parentheses. If “One Parent Is Deceased” then, mark the second statement. If both parents are alive and will sign this document but only one currently has custody of the Child/Minor, then mark the third checkbox. In case only one Parent has custody of the child and the other Parent’s whereabouts are unknown despite attempting to find them to serve notice (as per § 34-6-305)

3 – Describe When The Caregiver Will Be Granted Principal Powers And What Those Principal Powers Are

The Parental Principal Powers that will be delivered to the Caregiver will need to have a specific catalyst event to put them in Effect. In the sixth item, mark the parentheses that describes this event adequately. If these Powers go in Effect upon the Parent/Current Guardian’s debilitating illness or his or her incarceration, then select the first statement. The second statement should be selected to put these Powers into Effect, if/when the Principal/Current Guardian is detained, removed, or deported. The third statement should be marked if the Principal Powers here should be granted if/when the Child’s home is lost due to a Natural Disaster. The fourth statement will set the Parental Principal Powers as Effective if the Parent/Current Guardian must be hospitalized and/or needs medical and mental treatment (i.e. a heart attack, drug abuse, mental disease). The fifth statement will give the Caregiver these Principal Powers if the Parent/Current Guardian and/or Child falls into a physical and mental condition that prevents proper supervision. If another event will catalyze these Parental Powers into effect, then document this event on the blank lines after the word “Other (Please Describe)” One of these statements must be determined as the method defining when the Parental Powers are granted to the intended Caregiver.The seventh item (“7. I/We The Undersigned, Authorize the Named Caregiver”) will document what the Parental Powers being delegated to the intended Caregiver are and thus, in what capacity, the Caregiver will care for the child. One, some or all of the Power Statements in this item can be applied. If the intended Caregiver can “Enroll The Child In School” and after-school activities then mark the first statement. To appoint the Caregiver with the Parental Principal Power to seek and obtain “Medical, Dental, And Mental Health Treatment” for the Child/Minor, mark the second statement. The Parent/Current Guardian appoint the Caregiver with the Principal Power to see to the Child/Minor’s “Food, Lodging, Housing, Recreation, And Travel.” The Parent can also give specific Principal Powers to the Caregiver. If so, then record these Powers on the blank lines supplied in the last statement and mark the parentheses.

4 – The Parent/Current Guardian and Caregiver Must Acknowledge Several Disclosures

The eighth and ninth items will each need to be initialed by the Parent/Current Guardian issuing this Authority to the Caregiver. Item 8 will state this document does not grant legal custody to the Caregiver.Item 9 will be an acknowledgment these Powers can be revoked for the reasons it lists by the entities defined.The next five statements, “Part II” will need the acknowledgment initials of the intended Caregiver. He or she must read each statement. If the Caregiver comprehends and accepts these statements as true, he or she must initial them. If not, then it is recommended you seek legal advice since these Caregiver Acknowledgements are mandatory.Part III, item number 15, will contain a disclosure statement that both the Parent/Current Gaudian(s) and the intended Caregiver must read, comprehend, and initial. This statement will hold each responsible if fraudulent enrollment of the Child in an educational facility is the result of either the Caregiver or Parent’s actions.5 – A Notarized Signature From Each Individual Involved With this Delegation Must Be Provided

The Parent/Current Guardian(s) and the intended Caregiver must produce a notarized signature to this document for it to be executed. Three separate signature areas have been furnished for this purpose.

The Mother or Legal Guardian of the Child must sign the blank line above the words “Mother/Legal Guardian” then supply the Signature Date on the blank line labeled “Date.” The Notary Public will fill out the rest of this area to notarize the Mother or Legal Guardian’s Signature. The Father or Legal Guardian of the Child must sign the blank line labeled “Father/Legal Guardian” then record the current “Date” on the adjacent line. The remainder of this area may only be filled out by the attending Notary Public. Next, the intended Caregiver must sign his or her Name on the blank space labeled “Caregiver” then fill in his or her Signature Date on the next blank space, leaving the rest of this area to the Notary Public who will notarize his or her signing.


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