[NAME], the "parent" of [NAME], herewith appoints [NAME] of ____, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to do the following acts:
including the right to act entirely in loco parentis; including the authority to approve or to decline medical treatment of any kind for the child and including the right to review medical records or school records of the child.
This power of attorney shall be in effect from to .
__________________
------------------------, As Principal
STATE OF:
COUNTY OF:
personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.
Dated: ___________
___________________________
Notary Public
My comissio expires:
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