My daughter XXXXXXXXXXX has permission to participate in the Girl Scout Troop
183, Girl Scout Council of Colonial Coast, trip to England from August 22, 2000
through August 30, 2000. I understand that she will be traveling to England
escorted during all or part of the trip by her Girl Scout Troop Leader, Mrs. P.
Jann Schultz, and Troop Co-Leaders Mrs. Janice Pruden, Mrs. Terri Patterson and
Mrs. Deborah Flanagan.
KNOW ALL MEN BY THESE PRESENTS:
That I, XXXXXXX, a legal resident of Virginia Beach, Virginia and the parent
of XXXXXX (Date of Birth XXXXX), a minor, have made, constituted, and appointed,
and by these presents do make, constitute and appoint: Patricia Jann Schultz,
whose present address is 2000 Agnes Court, Virginia Beach, Virginia, my true and
lawful attorney as follows, GIVING and GRANTING, unto said attorney for medical
purposes full power to:
Seek, obtain and authorize medical treatment or care for XXXXXXXXX,
specifically including but not limited to, authority to seek medical treatment
by a pediatrician or any other doctor, to authorize admission to any hospital or
medical facility, to authorize any medical or surgical procedures to be
undertaken on said child which are deemed necessary by any doctors for his
health and well-being; and to seek and authorize emergency medical treatment,
the need for which may be occasioned by accident, injury, illness or any matter
endangering the health of said child.
FURTHER, I do authorize my aforesaid attorney-in-fact to perform all
necessary acts in the execution of the aforesaid authorization with the same
validity as I could effect if personally present. Any act or thing lawfully done
hereunder by my said attorney shall be binding on myself and my heirs, legal and
personal representative, and assigns.
PROVIDED, HOWEVER, that all business transacted hereunder for me in obtaining
medical attention for said child and all endorsements and instruments executed
by my said attorney for the purpose of carrying out the foregoing powers shall
contain my name, followed by that of my attorney and a designation
"attorney-in-fact".
FURTHER, unless sooner revoked or terminated by me, this special power of
attorney shall be come null and void from and after September 1, 2000.
__________________________________________
XXXXXXX
__________________________________________
XXXXXXX
COMMONWEALTH OF VIRGINIA
CITY OF VIRGINA BEACH, to-wit:
The foregoing instrument was subscribed and sworn to before me this day of
August, 2000.
Notary Public
My Commission Expires: