File:  JF-E-2  - Delegation of Custodial Power by Parent or Guardian

The undersigned, being the parent or guardian of ___________________, a minor child residing within the boundaries of Summit School District Re-1, pursuant to Colorado Revised Statutes, Section 15-14-105 does hereby designate and appoint _______________________, whose address is ____________________________, as his true and lawful attorney-in-fact for a period not exceeding nine months from the date hereof, and conferring upon said attorney-in-fact powers limited to the following:

Any and all power the undersigned may have regarding the care, custody or property of said minor child or ward, except the undersigned's power to consent to marriage or adoption of said minor child or ward, specifically including but not by way of limitation of this power the authority to make all decisions, consents, approvals and authorizations as may be required, appropriate or convenient in connection with said minor child's education in the public schools operated by Summit School District Re-1.

Dated this _______ day of _________, 20 ___.

_______________________________________

Parent or guardian

SUBSCRIBED AND SWORN to before me this ________ day of __________, 20___, by _________________________.

Witness my hand and official seal.

My commission expires: ___________________________________________

___________________________________________

Notary public

Revised:  April 22, 2014