{"data":{"id":"us-ky/krs-403.353","jurisdiction":"us-ky","citation":"KRS 403.353","heading":"Form of power of attorney authorized by this section, KRS 403.352, and","body":"KRS Chapter 403A.\n(1) A power of attorney established pursuant to this section, KRS 403.352, and KRS\nChapter 403A shall be substantially in the following form, and may i nclude other\nspecific directions which are in accordance with accepted legal practice and not\nspecifically prohibited by any other statute. If any other specific directions are held\nby a court of appropriate jurisdiction to be invalid, that invalidity shall not affect the\npower of attorney or other provisions established in this section, KRS 403.352, and\nKRS Chapter 403A.\n\"Power of Attorney for Temporary Delegation\nof Parental or Legal Custody and Care\n1. I certify that I am the parent or legal guardian of:\n__________________________________________   _______________\n(Full name of minor child)        (Date of birth)\n__________________________________________   _______________\n(Full name of minor child)        (Date of birth)\n__________________________________________   _______________\n(Full name of minor child)        (Date of birth)\n2. I designate __________________________ (Full name of Attorney-in-fact),\n_______________________________________________________________________\n(Street address, city, state, and zip code of Attorney-in-fact)\n_______________________________________________________________________\n(Home phone of Attorney-in-fact)____________________________________________\n(Work phone of Attorney-in-fact)____________________________________________\nas the Attorney-in-fact of each minor child named above.\n3. I delegate to the Attorney -in-fact all of my power and authority regarding the care,\ncustody, and property of each minor child named above, including but not limi ted to the\nright to enroll the child in school, inspect and obtain copies of education records and\nother records concerning the child, the right to attend school activities and other functions\nconcerning the child, and the right to give or withhold any con sent or waiver with respect\nto school activities, medical and dental treatment, and any other activity, function, or\ntreatment that may concern the child. This delegation shall not include the power or\nauthority to consent to marriage or adoption of the ch ild, the performance or inducement\nof an abortion on or for the child, or the termination of parental rights to the child.\nOR\nIn the event that Section 4 is completed, Section 3 does not apply.\n4. I delegate to the Attorney -in-fact the following specific p owers and responsibilities\n(write in):\n________________________________________________________________________\n________________________________________________________________________\n________________________________________________________________________\n________________________________________________________________________\n________________________________________________________________________\nThis delegation shall not include the power or authority to consent to marriage or\nadoption of the child, the performance or inducement of an abortion on or for the child, or\nthe termination of parental rights to the child.\n5. This power of attorney is effective for a period not to exceed one (1) year,\nbeginning _____________________, 20___,\nand ending _____________________, 20__.\nI reserve the right to revoke this authority at any time.\nOR\nIn the event Section 6 is completed and valid, Section 5 does not apply.\n6. I am a parent or legal guardian on active duty as governed by KRS Chapter 403A.\nMy active duty service is scheduled to begin on ___________________, 20__, and is\nestimated to end on __________________________, 20__. I acknowledge that in no\nevent may this delegation of power last more than one (1) year or the term of my active\nduty plus thirty (30) days, whichever is longer.\n7. BY: ______________________________________________________________\n(Parent/Legal Guardian signature)\n8. I hereby accept my designation as Attorney -in-fact for the minor child or children\nspecified in this power of attorney.\n__________________________________________________________\n(Attorney-in-fact signature)\nCounty of __________________\nACKNOWLEDGMENT\nBefore me, the undersigned, a Notary Public, in and for said County and State on this\n____day of ___________________________, 20___, personally appeared\n______________________________\n(Name of Parent/Legal Guardian)\n______________________________\n(Name of Attorney-in-fact),\nto me known to be the identical persons who executed this instrument and acknowledged\nto me that each executed the same as his or her free and voluntary act and deed for the\nuses and purposes set forth in the instrument.\nWitness my hand and official seal the day and year above written.\n_________________________\n(Signature of notary public)\nMy commission expires: _________________.\"\n(2) The power of attorney is legally sufficient under this section, KRS 403.352, and\nKRS Chapter 403A if the wording of the for m complies substantially with\nsubsection (1) of this section, the form is properly completed and signed, and the\nform or parties are not otherwise invalid pursuant to KRS 403.352.","path":["KRS Chapter 403"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51204","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:59:29Z","sha256":"1a450d6100215acc7ff7c1dc777905d37b6cde9be0a33b0661f443c67ca201e8","source_id":"us-ky","stale":false,"prev":"us-ky/krs-403.352","next":"us-ky/krs-403.355"},"notice":"GroundRules: Original legal text. Not legal advice."}