Alaska Stat. § 13.26.066
Section 1. I certify that I am theparent or guardian of
(Full name of minor child) (Date of birth)
(Full name of minor child) (Date of birth)
(Full name of minor child) (Date of birth)
who is/are minor children.
Section 2. I designate _____________________________________________________ (Full name of attorney- in-fact), _____________________________________
(Street address, city, state, and zip code of attorney-in-fact) _____________________________________
(Home telephone of (Work telephone of attorney-in-fact) attorney-in-fact)
as the attorney-in-fact of each minor child named above. Section 3. I delegate to the attorney-in-fact all of my power and authority regarding the care and custody of each minor child named above, including the right to enroll the child in school, the right to inspect and obtain copies of education records and other records concerning the child, the right to attend school activities and other functions concerning the child, and the right to give or withhold any consent or waiver with respect to school activities, medical treatment, dental treatment, and other activity, function, or treatment that may concern the minor child. This delegation does not include the power or authority to consent to the marriage or adoption of the minor child, the performance or inducement of an abortion on or for the minor child, or the termination of parental rights to the minor child. OR
Section 4. I delegate to my attorney-in-fact the following specific powers and responsibilities (write in): _____
Delegation under this section does not include the power or authority to consent to the marriage or adoption of the minor child, the performance or inducement of an abortion on or for the minor child, or the termination of parental rights to the minor child. (If you complete Section 4, Section 3 does not apply). Section 5. This power of attorney is effective for a period not to exceed one year, beginning __________, 20 _____, and ending __________, 20 _____. I reserve the right to revoke this authority at any time. OR
Section 6. I am a military parent or guardian under AS 13.26.066(d). My active duty is scheduled to begin on __________, 20 _____, and is estimated to end on __________, 20 _____. I acknowledge that this power of attorney will not last more than one year, or the term of my active duty service plus 30 days, whichever period is longer. By: _____________________________________________________
(Parent/guardian signature)
Section 7. I hereby accept my designation as attorney-in-fact for the minor child/children identified in this power of attorney. _____________________________________________________
(Attorney-in-fact signature)
State of __________________________________
________ Judicial District
ACKNOWLEDGMENT
Before me, the undersigned, a Notary Public, in and for the Judicial District and State identified above, on this _________ day of _________, 20 _____, personally appeared _____________________________________________________ (name of parent/guardian) and _____________________________________________________ (name of attorney-in-fact), to me known to be the persons who executed this power of attorney, and each acknowledged to me that each executed the same as the person's free and voluntary act and deed for the uses and purposes set out in this power of attorney. Witness my hand and official seal the day and year written above. (Signature of notary public) (Seal, if any)
_____________________________________________________
(Title and rank)
My commission expires: __________
AS 13.26.066