SB461,10 8Section 10. 48.979 (2) of the statutes is amended to read:
SB461,9,109 48.979 (2) A power of attorney complies with sub. (1) (a) if the power of attorney
10substantially conforms to the following form:
SB461,9,11 11power of attorney
SB461,9,12 12delegating parental power
SB461,9,13 13Authorized by s. 48.979, Wis. Stats.
SB461,9,1414 NAME(S) OF CHILD(REN)
SB461,9,1615 This power of attorney is for the purpose of providing for the care and custody
16of:
SB461,9,1717 Name, address, and date of birth of child ....
SB461,9,1818 Name, address, and date of birth of child ....
SB461,9,1919 Name, address, and date of birth of child ....
SB461,9,2020 DELEGATION OF POWER TO AGENT
SB461,9,2521 I, .... (name and address of parent), state that I have legal custody of the
22child(ren) named above. (Only a parent who has legal custody may use this form.)
23A parent may not use this form to delegate parental powers regarding a child who is
24subject to the jurisdiction of the juvenile court under
s. 48.13, 48.14, 938.12, 938.13,
25or 938.14, Wis. Stats.
SB461,10,1
1I delegate my parental power to:
SB461,10,22 Name of agent ....
SB461,10,33 Agent's address ....
SB461,10,44 Agent's telephone number(s) ....
SB461,10,55 Agent's e-mail address ....
SB461,10,66 Relationship of agent to child(ren) ....
SB461,10,77 The parental power I am delegating is as follows:
SB461,10,88 FULL
SB461,10,109 (Check if you want to delegate full parental power regarding the care and
10custody of the child(ren) named above.
)
SB461,10,1211 .... Full parental power regarding the care and custody of the child(ren) named
12above
SB461,10,1313 PARTIAL
SB461,10,1514 (Check each subject over which you want to delegate your parental power
15regarding the child(ren) named above.
)
SB461,10,1616 .... The power to consent to all health care; or
SB461,10,1717 .... The power to consent to only the following health care:
SB461,10,1918 .... Ordinary or routine health care, excluding major surgical procedures,
19extraordinary procedures, and experimental treatment
SB461,10,2020 .... Emergency blood transfusion
SB461,10,2121 .... Dental care
SB461,10,2222 .... Disclosure of health information about the child(ren)
SB461,10,2323 .... The power to consent to educational and vocational services
SB461,10,2424 .... The power to consent to the employment of the child(ren)
SB461,11,2
1.... The power to consent to the disclosure of confidential information, other
2than health information, about the child(ren)
SB461,11,33 .... The power to provide for the care and custody of the child(ren)
SB461,11,54 .... The power to consent to the child(ren) obtaining a motor vehicle operator's
5license
SB461,11,66 .... The power to travel with the child(ren) outside the state of Wisconsin
SB461,11,77 .... The power to obtain substitute care, such as child care, for the child(ren)
SB461,11,118 .... Other specifically delegated powers or limits on delegated powers (Fill in the
9following space or attach a separate sheet describing any other specific powers that
10you wish to delegate or any limits that you wish to place on the powers you are
11delegating.
) ....
SB461,11,1412 This delegation of parental powers does not deprive a custodial or noncustodial
13parent of any of his or her powers regarding the care and custody of the child,
14whether granted by court order or force of law.
SB461,11,2115 THIS DOCUMENT MAY NOT BE USED TO DELEGATE THE POWER TO
16CONSENT TO THE MARRIAGE OR ADOPTION OF THE CHILD(REN), THE
17PERFORMANCE OR INDUCEMENT OF AN ABORTION ON OR FOR THE
18CHILD(REN), THE TERMINATION OF PARENTAL RIGHTS TO THE
19CHILD(REN), THE ENLISTMENT OF THE CHILD(REN) IN THE U.S. ARMED
20FORCES OR TO PLACE THE CHILD(REN) IN A FOSTER HOME, GROUP HOME,
21OR INPATIENT TREATMENT FACILITY.
SB461,11,2322 EFFECTIVE DATE AND TERM
23 OF THIS DELEGATION
SB461,12,824 This Power of Attorney takes effect on .... and will remain in effect until .... If
25no termination date is given or if the termination date given is more than one year

1after the effective date of this Power of Attorney
, this Power of Attorney will remain
2in effect for a period of one year after the effective date, but no longer. If the
3termination date given is more than one year after the effective date of this Power
4of Attorney, this Power of Attorney must be approved by the juvenile court.
This
5Power of Attorney may be revoked in writing at any time by a parent who has legal
6custody of the child(ren) and such a revocation invalidates the delegation of parental
7powers made by this Power of Attorney, except with respect to acts already taken in
8reliance on this Power of Attorney.
SB461,12,99 SIGNATURE(S) OF PARENT(S)
SB461,12,1010 Signature of parent ....   Date ....
SB461,12,1111 Parent's name printed ....
SB461,12,1212 Parent's address ....
SB461,12,1313 Parent's telephone number ....
SB461,12,1414 Parent's e-mail address ....
SB461,12,1515 Signature of parent ....   Date ....
SB461,12,1616 Parent's name printed ....
SB461,12,1717 Parent's address ....
SB461,12,1818 Parent's telephone number ....
SB461,12,1919 Parent's e-mail address ....
SB461,12,2020 WITNESSING OF SIGNATURE(S) (OPTIONAL)
SB461,12,2121 State of ....
SB461,12,2222 County of ....
SB461,12,2323 This document was signed before me on .... (date) by .... (name(s) of parent(s)).
SB461,12,2424 Signature of notary ....
SB461,12,2525 My commission expires: ....
SB461,13,1
1STATEMENT OF AGENT
SB461,13,82 I, .... (name and address of agent), understand that .... (name(s) of parent(s)) has
3(have) delegated to me the powers specified in this Power of Attorney regarding the
4care and custody of .... (name(s) of child(ren)). I further understand that this Power
5of Attorney may be revoked in writing at any time by a parent who has legal custody
6of .... (name(s) of child(ren)). I hereby declare that I have read this Power of Attorney,
7understand the powers delegated to me by this Power of Attorney, am fit, willing, and
8able to undertake those powers, and accept those powers.
SB461,13,99 Agent's signature ....   Date ....
SB461,13,1010 APPENDIX
SB461,13,1211 (Here the parent(s) may indicate where they may be located during the term of
12the Power of Attorney if different from the address(es) set forth above.
)
SB461,13,1313 .... I can be located at:
SB461,13,1414 Address(es) ....
SB461,13,1515 Telephone number(s) ....
SB461,13,1616 E-mail address(es) ....
SB461,13,1717 .... Or, by contacting:
SB461,13,1818 Name ....
SB461,13,1919 Address ....
SB461,13,2020 Telephone number ....
SB461,13,2121 E-mail address ....
SB461,13,2222 .... Or, I cannot be located
SB461,11 23Section 11. 948.25 of the statutes is created to read:
SB461,14,3 24948.25 Unauthorized interstate placements of children. (1) Any person
25who sends a child out of this state, brings a child into this state, or causes a child to

1be sent out of this state or brought into this state for the purpose of permanently
2transferring physical custody of the child to a person who is not a relative of the child
3is guilty of a Class A misdemeanor.
SB461,14,4 4(2) Subsection (1) does not apply to any of the following:
SB461,14,55 (a) A placement of a child that is authorized under s. 48.98, 48.988, or 48.99.
SB461,14,76 (b) A placement of a child that is approved by a court of competent jurisdiction
7of the sending state or receiving state.
SB461,12 8Section 12. Nonstatutory provisions.
SB461,14,129 (1) Study of adoption disruption and dissolution. The joint legislative council
10is requested to study adoption disruption and dissolution in this state. If the joint
11legislative council undertakes such a study, the joint legislative council shall do all
12of the following:
SB461,14,1513 (a) Study the extent of adoption disruption and dissolution in this state and the
14efforts by the department of children and families, counties, and child welfare
15agencies to prevent such disruption and dissolution.
SB461,14,1616 (b) Recommend legislation to accomplish all of the following:
SB461,14,17 171. Define adoption disruption and adoption dissolution.
SB461,14,18 182. Prevent adoption disruption and adoption dissolution in this state.
SB461,14,22 193. Require the department of children and families, county departments of
20human services or social services that are authorized to place children for adoption,
21and child welfare agencies that are licensed to place children for adoption to track
22and report on disrupted or dissolved adoptions.
SB461,14,2423 (c) Consider legislative options to prepare prospective adoptive parents for
24adoption and to support adoptive parents after an adoption.
SB461,15,2
1(d) Submit its findings, conclusions, and recommendations to the 2015
2legislature when it commences.
SB461,13 3Section 13. Initial applicability.
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