Agent's telephone number(s) ....
Agent's e-mail address ....
Relationship of agent to child(ren) ....
The parental power I am delegating is as follows:
full
(Check if you want to delegate full parental power regarding the care and custody of the child(ren) names above.)
.... Full parental power regarding the care and custody of the child(ren) named above
partial
(Check each subject over which you want to delegate your parental power regarding the child(ren) names above.)
.... The power to consent to all health care; or
.... The power to consent to only the following health care:
.... Ordinary or routine health care, excluding major surgical procedures, extraordinary procedures, and experimental treatment
.... Emergency blood transfusion
.... Dental care
.... Disclosure of health information about the child(ren)
.... The power to consent to educational and vocational services
.... The power to consent to the employment of the child(ren)
.... The power to consent to the disclosure of confidential information, other than health information, about the child(ren)
.... The power to provide for the care and custody of the child(ren)
.... The power to consent to the child(ren) obtaining a motor vehicle operator's license
.... The power to travel with the child(ren) outside the state of Wisconsin
.... The power to obtain substitute care, such as child care, for the child(ren)
.... Other specifically delegated powers or limits on delegated powers (Fill in the following space or attach a separate sheet describing any other specific powers that you wish to delegate or any limits that you wish to place on the powers you are delegating.) ....
This delegation of parental powers does not deprive a custodial or noncustodial parent of any of his or her powers regarding the care and custody of the child, whether granted by court order or force of law.
THIS DOCUMENT MAY NOT BE USED TO DELEGATE THE POWER TO CONSENT TO THE MARRIAGE OR ADOPTION OF THE CHILD(REN), THE PERFORMANCE OR INDUCEMENT OF AN ABORTION ON OR FOR THE CHILD(REN), THE TERMINATION OF PARENTAL RIGHTS TO THE CHILD(REN), THE ENLISTMENT OF THE CHILD(REN) IN THE U.S. ARMED FORCES OR TO PLACE THE CHILD(REN) IN A FOSTER HOME, GROUP HOME, OR INPATIENT TREATMENT FACILITY.
EFFECTIVE DATE AND TERM
OF THIS DELEGATION
This Power of Attorney takes effect on .... and will remain in effect until .... If no termination date is given or if the termination date given is more than one year after the effective date of this Power of Attorney, this Power of Attorney will remain in effect for a period of one year after the effective date, but no longer. This Power of Attorney may be revoked in writing at any time by a parent who has legal custody of the child(ren) and such a revocation invalidates the delegation of parental powers made by this Power of Attorney, except with respect to acts already taken in reliance on this Power of Attorney.
SIGNATURE(S) OF PARENT(S)
Signature of parent .... Date ....
Parent's name printed ....
Parent's address ....
Parent's telephone number ....
Parent's e-mail address ....
Signature of parent .... Date ....
Parent's name printed ....
Parent's address ....
Parent's telephone number ....
Parent's e-mail address ....
WITNESSING OF SIGNATURE(S) (OPTIONAL)
State of ....
County of ....
This document was signed before me on .... (date) by .... (name(s) of parent(s)).
Signature of notary ....
My commission expires: ....
STATEMENT OF AGENT
I, .... (name and address of agent), understand that .... (name(s) of parent(s)) has (have) delegated to me the powers specified in this Power of Attorney regarding the care and custody of .... (name(s) of child(ren)). I further understand that this Power of Attorney may be revoked in writing at any time by a parent who has legal custody of .... (name(s) of child(ren)). I hereby declare that I have read this Power of Attorney, understand the powers delegated to me by this Power of Attorney, am fit, willing, and able to undertake those powers, and accept those powers.
Agent's signature .... Date ....
APPENDIX
(Here the parent(s) may indicate where they may be located during the term of the Power of Attorney if different from the address(es) set forth above.)
.... I can be located at:
Address(es) ....
Telephone number(s) ....
E-mail address(es) ....
.... Or, by contacting:
Name ....
Address ....
Telephone number ....
E-mail address ....
.... Or, I cannot be located
(3) (a) In this subsection:
1. "Agent" means a person to whom delegation of the care and custody of a child under this section is facilitated by an organization.
2. "Organization" means an organization that facilitates delegations of the care and custody of children under this section.
(b) The department may promulgate rules to implement this section. If the department promulgates those rules, those rules shall include rules establishing all of the following:
1. Training requirements for the staff of an organization, including training in identifying children who have been abused or neglected and the laws and procedures under s. 48.981 governing the reporting of suspected or threatened child abuse or neglect.
2. Screening and assessment requirements for a proposed agent, including a screening of the personal characteristics, health, and finances of the proposed agent and of the physical environment and safety of the proposed agent's home and, based on that screening, an assessment of the proposed agent's fitness to provide for the care and custody of the child and ability to meet the child's needs. The rules promulgated under this subdivision shall prohibit an organization from facilitating a delegation of the care and custody of a child to a proposed agent unless the proposed agent is fit to provide for the care and custody of the child and able to meet the child's needs.
3. Training requirements for an agent, including the training described in subd. 1. and training in the expectations of an agent specified in subd. 4.
4. The expectations of an agent with respect to the care and custody of the child, including expectations relating to the care, nurturing, protection, training, guidance, and discipline of the child; the provision of food, shelter, education, and health care for the child; cooperation with the child's parents in coparenting the child; and cooperation with the organization in facilitating visitation and other communications with the child's parents and in otherwise complying with the expectations of the organization.
5. A requirement that an organization regularly monitor an agent and the child whose care and custody is delegated to the agent and maintain communications with the child's parents.
87,21
Section
21. 48.981 (2) (a) (intro.) of the statutes is amended to read:
48.981 (2) (a) (intro.) Any of the following persons who has reasonable cause to suspect that a child seen by the person in the course of professional duties has been abused or neglected or who has reason to believe that a child seen by the person in the course of professional duties has been threatened with abuse or neglect and that abuse or neglect of the child will occur shall, except as provided under sub. subs. (2m) and (2r), report as provided in sub. (3):
87,22
Section
22. 48.981 (2) (b) of the statutes is amended to read:
48.981 (2) (b) A court-appointed special advocate who has reasonable cause to suspect that a child seen in the course of activities under s. 48.236 (3) has been abused or neglected or who has reason to believe that a child seen in the course of those activities has been threatened with abuse and neglect and that abuse or neglect of the child will occur shall, except as provided in sub.
subs. (2m) and (2r), report as provided in sub. (3).
87,23
Section
23. 48.981 (2) (bm) 1. (intro.) of the statutes is amended to read:
48.981 (2) (bm) 1. (intro.) Except as provided in subd. 3. and sub. subs. (2m) and (2r), a member of the clergy shall report as provided in sub. (3) if the member of the clergy has reasonable cause to suspect that a child seen by the member of the clergy in the course of his or her professional duties:
87,24
Section
24. 48.981 (2) (bm) 2. (intro.) of the statutes is amended to read:
48.981 (2) (bm) 2. (intro.) Except as provided in subd. 3. and sub. subs. (2m) and (2r), a member of the clergy shall report as provided in sub. (3) if the member of the clergy has reasonable cause, based on observations made or information that he or she receives, to suspect that a member of the clergy has done any of the following:
87,25
Section
25. 48.981 (2m) (title) of the statutes is amended to read:
48.981 (2m) (title) Exception to reporting requirement; health care services.
87,26
Section
26. 48.981 (2r) of the statutes is created to read:
48.981 (2r) Exception to reporting requirement; person delegated parental powers. A person delegated care and custody of a child under s. 48.979 is not required to report as provided in sub. (3) any suspected or threatened abuse or neglect of the child as required under sub. (2) (a), (b), or (bm) or (2m) (d) or (e). Such a person who has reason to suspect that the child has been abused or neglected or who has reason to believe that the child has been threatened with abuse or neglect and that abuse or neglect of the child will occur may report as provided in sub. (3).
