AB674,10,2121 Parent's address ....
AB674,10,2222 Parent's telephone number ....
AB674,10,2323 Parent's e-mail address ....
AB674,10,2424 WITNESSING OF SIGNATURE(S) (OPTIONAL)
AB674,10,2525 State of ....
AB674,11,1
1County of ....
AB674,11,22 This document was signed before me on .... (date) by .... (name(s) of parent(s)).
AB674,11,33 Signature of notary ....
AB674,11,44 My commission expires: ....
AB674,11,55 STATEMENT OF AGENT
AB674,11,126 I, .... (name and address of agent), understand that .... (name(s) of parent(s)) has
7(have) delegated to me the powers specified in this Power of Attorney regarding the
8care and custody of .... (name(s) of child(ren)). I further understand that this Power
9of Attorney may be revoked in writing at any time by a parent who has legal custody
10of .... (name(s) of child(ren)). I hereby declare that I have read this Power of Attorney,
11understand the powers delegated to me by this Power of Attorney, am fit, willing, and
12able to undertake those powers, and accept those powers.
AB674,11,1313 Agent's signature ....   Date ....
AB674,11,1414 APPENDIX
AB674,11,1615 (Here the parent(s) may indicate where they may be located during the term of
16the Power of Attorney if different from the address(es) set forth above.
)
AB674,11,1717 .... I can be located at:
AB674,11,1818 Address(es) ....
AB674,11,1919 Telephone number(s) ....
AB674,11,2020 E-mail address(es) ....
AB674,11,2121 .... Or, by contacting:
AB674,11,2222 Name ....
AB674,11,2323 Address ....
AB674,11,2424 Telephone number ....
AB674,11,2525 E-mail address ....
AB674,12,1
1.... Or, I cannot be located
AB674,16 2Section 16. 253.10 (3) (c) 2. c. of the statutes is amended to read:
AB674,12,83 253.10 (3) (c) 2. c. That the woman has a legal right to continue her pregnancy
4and to keep the child; to place the child in a foster home for 6 months or, in a group
5home for 15 days, or in a shelter care facility approved under s. 938.22 (2) (c) for 20
6days;
to petition a court for placement of the child in a foster home or group home or
7with a relative; or to place the child for adoption under a process that involves court
8approval both of the voluntary termination of parental rights and of the adoption.
AB674,17 9Section 17. 938.22 (2) (c) of the statutes is amended to read:
AB674,12,2410 938.22 (2) (c) A shelter care facility shall may be used for the temporary care
11of juveniles children taken into custody under s. 48.19, in need of transitional
12placements in emergency situations under s. 48.357 (2m), or placed in the shelter
13care facility by order of the court under ch. 48 and of juveniles taken into custody
14under s. 938.19, in need of transitional placements in emergency situations under
15s. 938.357 (2m), or placed in the shelter care facility by order of the court under this
16chapter, except that on the request of a person licensed to operate a shelter care
17facility the department of children and families may permit that shelter care facility
18to be used for voluntary placements under s. 48.63 (1) (b). The department of
19children and families shall review such a request based on the needs of children and
20juveniles in the area served by the shelter care facility and the services provided by
21the shelter care facility and may approve the request if it determines that the
22services provided by the shelter care facility would meet those needs
. A shelter care
23facility, other than a holdover room, may not be in the same building as a facility for
24the detention of adults.
AB674,18 25Section 18. 938.38 (2) (d) of the statutes is amended to read:
AB674,13,2
1938.38 (2) (d) The juvenile was placed under a voluntary agreement between
2the agency and the juvenile's parent under s. 48.63 (1) (a) or (5) (b).
AB674,13,33 (End)
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