Okla. Stat. tit. 10, § 10-701: Statutory form for power of attorney to delegate parental

or legal custodian powers.

A. The following statutory form of power of attorney to

delegate parental or legal authority as authorized by Section 1 of

this act is legally sufficient:

Statutory Form for Power of Attorney to Delegate Parental or Legal

Custodian Powers

1. "I certify that I am the parent or legal custodian of:

_____________________________________ ___________________________

(Full name of minor child) (Date of birth)

_____________________________________ ___________________________

(Full name of minor child) (Date of birth)

_____________________________________ ___________________________

(Full name of minor child) (Date of birth)

(minor child(ren))."

2. "I designate

___________________________________________________,

(Full name of Attorney-in-fact)

___________________________________________________________________,

(Street address, city, state and zip code of Attorney-in-fact)

_________________________________ _________________________________

(Home phone of Attorney-in-fact) (Work phone of Attorney-in-fact)

as the attorney-in-fact of each minor child named above."

3. _______"I delegate to the attorney-in-fact all of my power

and authority regarding the care, custody and property of each minor

child named above, including but not limited to the right to enroll

the child in school, inspect and obtain copies of education records

and other records concerning the child, the right to attend school

activities and other functions concerning the child, and the right

to give or withhold any consent or waiver with respect to school

activities, medical and dental treatment, and any other activity,

function or treatment that may concern the child. This delegation

shall not include the power or authority to consent to marriage or

adoption of the child, the performance or inducement of an abortion

on or for the child, or the termination of parental rights to the

child." or

4. _______"I delegate to the attorney-in-fact the following

specific powers and responsibilities (write in):

____________________________________________________________________

This delegation shall not include the power or authority to consent

to marriage or adoption of the child, the performance or inducement

of an abortion on or for the child, or the termination of parental

rights to the child."

5. "This power of attorney is effective for a period not to

exceed one year, beginning _______________, 20__, and ending

______________, 20__. I reserve the right to revoke this authority

at any time."

By:__________________________________

(Parent/Legal Custodian signature)

6. "I hereby accept my designation as attorney-in-fact for

____________________________________________________________________

(Minor child(ren)) as specified in this power of attorney."

_______________________________

(Attorney-in-fact signature)

State of ____________

County of ___________

ACKNOWLEDGEMENT

Before me, the undersigned, a Notary Public, in and for said

County and State on this _____ day of ___________________, 20__,

personally appeared _____________________________ (Name of

Parent/Legal Custodian) and ___________________________ (Name of

Attorney-in-fact), to me known to be the identical persons who

executed this instrument and acknowledged to me that each executed

the same as his or her free and voluntary act and deed for the uses

and purposes set forth in the instrument.

Witness my hand and official seal the day and year above written.

_______________________________

(Signature of notarial officer)

(Seal, if any)

______________________________

(Title and Rank)

My commission expires: ___________

B. The power of attorney is legally sufficient under this act,

if the wording of the form complies substantially with subsection A

of this section, the form is properly completed, and the signatures

of the parties are acknowledged.