I delegate my parental power to:
Name of agent ....
Agent's address ....
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) named 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) named 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
48.979(3)(a)1.
1. "Agent" means a person to whom delegation of the care and custody of a child under this section is facilitated by an organization.
48.979(3)(a)2.
2. "Organization" means an organization that facilitates delegations of the care and custody of children under this section.
48.979(3)(b)
(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:
48.979(3)(b)1.
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.
48.979(3)(b)2.
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.
48.979(3)(b)3.
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.
48.979(3)(b)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.
48.979(3)(b)5.
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.
48.979 History
History: 2011 a. 87; correction in (2) (form) under 35.17.
MISCELLANEOUS PROVISIONS
48.98
48.98
Interstate placement of children. 48.98(1)
(1) No person may bring a child into this state or send a child out of this state for the purpose of placing the child in foster care or for the purpose of adoption without a certificate from the department that the home is suitable for the child.
48.98(2)(a)(a) Any person, except a county department or licensed child welfare agency, who brings a child into this state for the purpose of placing the child in a foster home shall, before the child's arrival in this state, file with the department a $1,000 noncancelable bond in favor of this state, furnished by a surety company licensed to do business in this state. The condition of the bond shall be that the child will not become dependent on public funds for his or her primary support before the child reaches age 18 or is adopted.
48.98(2)(b)
(b) By filing the bond required under
par. (a), the person filing the bond and the surety submit to the jurisdiction of the court in the county in which the person resides for purposes of liability on the bond, and appoint the clerk of the court as their agent upon whom any papers affecting their bond liability may be served.
48.98(2)(c)
(c) If upon affidavit of the department it appears to the court that the condition of the bond has been violated, the court shall order the person who filed the bond and the surety to show cause why judgment on the bond should not be entered for the department. If neither the person nor the surety appears for the hearing on the order to show cause, or if the court concludes after the hearing that the condition of the bond has been violated, the court shall enter judgment on the bond for the department against the person who filed the bond and the surety.
48.98(2)(d)
(d) The department shall periodically bill the person who filed the bond and the surety under
s. 49.32 (1) (b) or
49.345 for the cost of care and maintenance of the child until the child is adopted or becomes age 18, whichever is earlier. The guardian and surety shall also be liable under the bond for costs incurred by the department in enforcing the bond.
48.98(2)(e)
(e) The department may waive the bond requirement under
par. (a).
48.98(3)
(3) The person bringing or sending the child into or out of this state shall report to the department, at least once each year and at any other time required by the department, concerning the location and well-being of the child, until the child is 18 years of age or is adopted.
48.98(4)(a)(a) This section applies only to interstate placements of children that are not governed by
s. 48.988 or
48.99.
48.98(4)(b)
(b) Section 48.839 governs the placement of children who are not U.S. citizens and not under agency guardianship who are brought into this state from a foreign jurisdiction for the purpose of adoption.
48.98(5)
(5) The department may promulgate all rules necessary for the enforcement of this section.
