AB674: Bill Text

AB674,8,6 I, .... (name and address of parent), state that I have legal custody of the child(ren) named above. (Only a parent who has legal custody may use this form.) A parent may not use this form to delegate parental powers regarding a child who is subject to the jurisdiction of the juvenile court under s. 48.13, 48.14, 938.12, 938.13, or 938.14, Wis. Stats.

AB674,8,7 I delegate my parental power to:

AB674,8,8 Name of agent ....

AB674,8,9 Agent's address ....

AB674,8,10 Agent's telephone number(s) ....

AB674,8,11 Agent's e-mail address ....

AB674,8,12 Relationship of agent to child(ren) ....

AB674,8,13 The parental power I am delegating is as follows:

AB674,8,14 FULL

AB674,8,16 (Check if you want to delegate full parental power regarding the care and custody of the child(ren) named above.)

AB674,8,18 .... Full parental power regarding the care and custody of the child(ren) named above

AB674,8,19 PARTIAL

AB674,8,21 (Check each subject over which you want to delegate your parental power regarding the child(ren) named above.)

AB674,8,22 .... The power to consent to all health care; or

AB674,8,23 .... The power to consent to only the following health care:

AB674,8,25 .... Ordinary or routine health care, excluding major surgical procedures, extraordinary procedures, and experimental treatment

AB674,9,1 .... Emergency blood transfusion

AB674,9,2 .... Dental care

AB674,9,3 .... Disclosure of health information about the child(ren)

AB674,9,4 .... The power to consent to educational and vocational services

AB674,9,5 .... The power to consent to the employment of the child(ren)

AB674,9,7 .... The power to consent to the disclosure of confidential information, other than health information, about the child(ren)

AB674,9,8 .... The power to provide for the care and custody of the child(ren)

AB674,9,10 .... The power to consent to the child(ren) obtaining a motor vehicle operator's license

AB674,9,11 .... The power to travel with the child(ren) outside the state of Wisconsin

AB674,9,12 .... The power to obtain substitute care, such as child care, for the child(ren)

AB674,9,16 .... 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.) ....

AB674,9,19 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.

AB674,9,24 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, SHELTER CARE FACILITY, OR INPATIENT TREATMENT FACILITY.

AB674,10,4 EFFECTIVE DATE AND TERM OF THIS DELEGATION

AB674,10,12 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.

AB674,10,13 SIGNATURE(S) OF PARENT(S)

AB674,10,14 Signature of parent ....   Date ....

AB674,10,15 Parent's name printed ....

AB674,10,16 Parent's address ....

AB674,10,17 Parent's telephone number ....

AB674,10,18 Parent's e-mail address ....

AB674,10,19 Signature of parent ....   Date ....

AB674,10,20 Parent's name printed ....

AB674,10,21 Parent's address ....

AB674,10,22 Parent's telephone number ....

AB674,10,23 Parent's e-mail address ....

AB674,10,24 WITNESSING OF SIGNATURE(S) (OPTIONAL)

AB674,10,25 State of ....

AB674,11,1 County of ....

AB674,11,2 This document was signed before me on .... (date) by .... (name(s) of parent(s)).

AB674,11,3 Signature of notary ....

AB674,11,4 My commission expires: ....

AB674,11,5 STATEMENT OF AGENT

AB674,11,12 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.

AB674,11,13 Agent's signature ....   Date ....

AB674,11,14 APPENDIX

AB674,11,16 (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.)

AB674,11,17 .... I can be located at:

AB674,11,18 Address(es) ....

AB674,11,19 Telephone number(s) ....

AB674,11,20 E-mail address(es) ....

AB674,11,21 .... Or, by contacting:

AB674,11,22 Name ....

AB674,11,23 Address ....

AB674,11,24 Telephone number ....

AB674,11,25 E-mail address ....

AB674,12,1 .... Or, I cannot be located

AB674,16 Section 16. 253.10 (3) (c) 2. c. of the statutes is amended to read:

AB674,12,8 253.10 (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.

AB674,17 Section 17. 938.22 (2) (c) of the statutes is amended to read:

AB674,12,24 938.22 (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.

AB674,18 Section 18. 938.38 (2) (d) of the statutes is amended to read:

AB674,13,2 938.38 (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).

AB674,13,3 (End)