2017 Georgia Code
Title 19 - Domestic Relations
Chapter 9 - Child Custody Proceedings
Article 4 - Power of Attorney for the Care of a Minor Child
§ 19-9-129. Power of attorney form

Universal Citation: GA Code § 19-9-129 (2017)
  • (a) The statutory power of attorney for the care of a minor child form contained in this Code section may be used to grant an agent grandparent powers over the minor child's enrollment in school, medical, dental, and mental health care, food, lodging, recreation, travel, and any additional powers as specified by the parent. This power of attorney is not intended to be exclusive. No provision of this article shall be construed to bar use by the parent of any other or different form of power of attorney for the care of a minor child which complies with this article. A power of attorney for the care of a minor child in substantially the form set forth in this Code section shall have the same meaning and effect as prescribed in this article. Substantially similar forms may include forms from other states.
  • (b) The power of attorney for the care of a minor child shall be in substantially the following form:

    "GEORGIA POWER OF ATTORNEY FOR THE CARE OF A MINOR CHILD

    NOTICE:

    • (1) THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE GRANDPARENT THAT

      YOU DESIGNATE (THE AGENT GRANDPARENT) POWERS TO CARE FOR YOUR MINOR CHILD,

      INCLUDING THE POWER TO: ENROLL THE CHILD IN SCHOOL AND IN EXTRACURRICULAR

      SCHOOL ACTIVITIES; HAVE ACCESS TO SCHOOL RECORDS AND DISCLOSE THE CONTENTS

      TO OTHERS; ARRANGE FOR AND CONSENT TO MEDICAL, DENTAL, AND MENTAL HEALTH

      TREATMENT FOR THE CHILD; HAVE ACCESS TO SUCH RECORDS RELATED TO TREATMENT

      OF THE CHILD AND DISCLOSE THE CONTENTS OF THOSE RECORDS TO OTHERS; PROVIDE

      FOR THE CHILD'S FOOD, LODGING, RECREATION, AND TRAVEL; AND HAVE ANY

      ADDITIONAL POWERS AS SPECIFIED BY THE PARENT.

    • (2) THE AGENT GRANDPARENT IS REQUIRED TO EXERCISE DUE CARE TO ACT IN THE

      CHILD'S BEST INTEREST AND IN ACCORDANCE WITH THE GRANT OF AUTHORITY

      SPECIFIED IN THIS FORM.

    • (3) A COURT OF COMPETENT JURISDICTION MAY REVOKE THE POWERS OF THE AGENT

      GRANDPARENT IF IT FINDS THAT THE AGENT GRANDPARENT IS NOT ACTING PROPERLY.

    • (4) THE AGENT GRANDPARENT MAY EXERCISE THE POWERS GIVEN IN THIS POWER OF

      ATTORNEY FOR THE CARE OF A MINOR CHILD THROUGHOUT THE CHILD'S MINORITY

      UNLESS THE PARENT REVOKES THIS POWER OF ATTORNEY AND PROVIDES NOTICE OF THE

      REVOCATION TO THE AGENT GRANDPARENT OR UNTIL A COURT OF COMPETENT

      JURISDICTION TERMINATES THIS POWER.

    • (5) THE AGENT GRANDPARENT MAY RESIGN AS AGENT AND MUST IMMEDIATELY

      COMMUNICATE SUCH RESIGNATION TO THE PARENT, AND IF COMMUNICATION WITH SUCH

      PARENT IS NOT POSSIBLE, THE AGENT GRANDPARENT SHALL NOTIFY CHILD PROTECTIVE

      SERVICES OR SUCH GOVERNMENT AUTHORITY THAT IS CHARGED WITH ASSURING PROPER

      CARE OF SUCH MINOR CHILD.

    • (6) THIS POWER OF ATTORNEY MAY BE REVOKED IN WRITING BY ANY AUTHORIZING

      PARENT. IF THE POWER OF ATTORNEY IS REVOKED, THE REVOKING PARENT SHALL

      NOTIFY THE AGENT GRANDPARENT, SCHOOL, HEALTH CARE PROVIDERS, AND OTHERS

      KNOWN TO THE PARENT TO HAVE RELIED UPON SUCH POWER OF ATTORNEY.

    • (7) IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU

      SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.

      POWER OF ATTORNEY FOR THE CARE OF A MINOR CHILD

      made this ____ day of ____, ____.

      • (1) (A) I, ____ (insert name and address of parent or

        parents), hereby appoint ____ (insert name and address of grandparent to

        be named as agent) as attorney in fact (the agent grandparent) for my child

        ____ (insert name of child) to act for me and in my name in any way that

        I could act in person.

        • (B) I hereby certify that the agent grandparent named herein is the

          (place a check mark beside the appropriate description):

          ____ Biological grandparent;

          ____ Stepgrandparent;

          ____ Biological great-grandparent; or

          ____ Stepgreat-grandparent.

      • (2) The agent grandparent may:
        • (A) Enroll the child in school and in extracurricular activities,

          have access to school records, and may disclose the contents to others;

        • (B) Arrange for and consent to medical, dental, and mental health

          treatment of the child, have access to such records related to treatment of

          the child, and disclose the contents of such records to others;

        • (C) Provide for the child's food, lodging, recreation, and travel; and
        • (D) Carry out any additional powers specified by the parent as

          follows:

          ____

          ____

          ____

      • (3) The powers granted above shall not include the following powers or

        shall be subject to the following rules or limitations (here you may include

        any specific limitations that you deem appropriate):

        ____

        ____

        ____

      • (4) This power of attorney for the care of a minor child is being

        executed because of the following hardship (initial all that apply):

        ____ (A) The death, serious illness, or terminal illness of a parent;

        ____ (B) The physical or mental condition of the parent or the child

        such that proper care and supervision of the child cannot be provided by the

        parent;

        ____ (C) The loss or uninhabitability of the child's home as the result

        of a natural disaster;

        ____ (D) The incarceration of a parent; or

        ____ (E) A period of active military duty of a parent.

      • (5) (Optional) If a guardian of my minor child is to be appointed, I

        nominate the following person to serve as such guardian:____

        (insert name and address of person nominated to be guardian of the minor child).

      • (6) I am fully informed as to all of the contents of this form and I

        understand the full import of this grant of powers to the agent grandparent.

      • (7) I certify that the minor child is not emancipated, and, if the minor

        child becomes emancipated, this power of attorney shall no longer be valid.

      • (8) Except as may be permitted by the federal No Child Left Behind Act,

        20 U.S.C.A. Section 6301, et seq., and Section 7801, et seq., I hereby certify

        that this power of attorney is not executed for the primary purpose of

        unlawfully enrolling the child in a school so that the child may participate

        in the academic or interscholastic athletic programs provided by that school.

      • (9) I certify that, to my knowledge, the minor child's welfare is not

        the subject of an investigation by the Department of Human Services.

      • (10) I declare under penalty of perjury under the laws of the State of

        Georgia that the foregoing is true and correct.

        Parent Signature:____

        Printed name:____

        Parent Signature:____

        Printed name:____

        Signed and sealed in the presence of:____

        Notary public

        My commission expires

        ____"

  • (c) The following notice shall be attached to the power of attorney:

    "ADDITIONAL INFORMATION:

    To the grandparent designated as attorney in fact:

    • (1) If a change in circumstances results in the child not living with

      you for more than six weeks during a school term and such change is not due to

      hospitalization, vacation, study abroad, or some reason otherwise acceptable

      to the school, you should notify in writing the school in which you have

      enrolled the child and to which you have given this power of attorney form.

    • (2) You have the authority to act on behalf of the minor child until

      each parent who executed the power of attorney for the care of the minor child

      revokes the power of attorney in writing and provides notice of revocation to

      you as provided in O.C.G.A. Section 19-9-128.

    • (3) If you are made aware of the death of the parent who executed the

      power of attorney, you must notify the surviving parent as soon as

      practicable. With the consent of the surviving parent, or if the whereabouts

      of the surviving parent are unknown, the power of attorney may continue for up

      to six months so that the child may receive consistent care until more

      permanent custody arrangements are made.

    • (4) You may resign as agent by notifying each parent in writing by

      certified mail or statutory overnight delivery, return receipt requested, and

      if you become unable to care for the child, you shall cause such resignation

      to be communicated to the parent. If communication with such parent is not

      possible, you must notify child protective services or such government

      authority that is charged with assuring proper care of such minor child.

      To school officials:

      • (1) Except as provided in the policies and regulations of the county

        school board and the federal No Child Left Behind Act, 20 U.S.C.A. Section

        6301, et seq., and Section 7801, et seq., this power of attorney, properly

        completed and notarized, authorizes the agent grandparent named herein to

        enroll the child named herein in school in the district in which the agent

        grandparent resides. That agent grandparent is authorized to provide consent

        in all school related matters and to obtain from the school district

        educational and behavioral information about the child. Furthermore, this

        power of attorney shall not prohibit the parent of the child from having

        access to all school records pertinent to the child.

      • (2) The school district may require such residency documentation as is

        customary in that school district.

      • (3) No school official who acts in good faith reliance on a power of

        attorney for the care of a minor child shall be subject to criminal or civil

        liability or professional disciplinary action for such reliance.

        To health care providers:

        • (1) No health care provider who acts in good faith reliance on a power

          of attorney for the care of a minor child shall be subject to criminal or

          civil liability or professional disciplinary action for such reliance.

        • (2) The parent continues to have the right to all medical, dental, and

          mental health records pertaining to the minor child."

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