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
335,16
Section
16. 253.10 (3) (c) 2. c. of the statutes is amended to read:
253.10 (3) (c) 2. c. That the woman has a legal right to continue her pregnancy and to keep the child; to place the child in a foster home for 6 months or, in a group home for 15 days, or in a shelter care facility approved under s. 938.22 (2) (c) for 20 days; to petition a court for placement of the child in a foster home or group home or with a relative; or to place the child for adoption under a process that involves court approval both of the voluntary termination of parental rights and of the adoption.
335,17
Section
17. 938.22 (2) (c) of the statutes is amended to read:
938.22 (2) (c) A shelter care facility shall may be used for the temporary care of juveniles children taken into custody under s. 48.19, in need of transitional placements in emergency situations under s. 48.357 (2m), or placed in the shelter care facility by order of the court under ch. 48 and of juveniles taken into custody under s. 938.19, in need of transitional placements in emergency situations under s. 938.357 (2m), or placed in the shelter care facility by order of the court under this chapter, except that on the request of a person licensed to operate a shelter care facility the department of children and families may permit that shelter care facility to be used for voluntary placements under s. 48.63 (1) (b). The department of children and families shall review such a request based on the needs of children and juveniles in the area served by the shelter care facility and the services provided by the shelter care facility and may approve the request if it determines that the services provided by the shelter care facility would meet those needs. A shelter care facility, other than a holdover room, may not be in the same building as a facility for the detention of adults.
335,18
Section
18. 938.38 (2) (d) of the statutes is amended to read:
938.38 (2) (d) The juvenile was placed under a voluntary agreement between the agency and the juvenile's parent under s. 48.63 (1) (a) or (5) (b).
