" ิHE UNDERSIGNED PARENT(S), \A, RESIDING AT " " " \B " " \C " " \D " " \E " " " HEREBY APPOINT(S) \F, RESIDING AT " " " \G " " \H " " \I " " \J " " " AS THE LEGAL GUARDIAN(S) OF THE PERSON(S) OF MY CHILD(REN): " " " \K " " \L " " \M " " " ิHIS GUARDIANSHIP SHALL BEGIN ON THE \N DAY OF \O, \P, AND SHALL "REMAIN IN EFFECT THROUGH THE \Q DAY OF \R, \S." " " ิHE ABOVE NAMED GUARDIAN(S) SHALL HAVE THE FOLLOWING POWERS: " " "1. ิHE POWER TO SEEK APPROPRIATE MEDICAL TREATMENT OR ATTENTION ON "BEHALF OF MY CHILD AS MAY BE REQUIRED BY THE CIRCUMSTANCES, INCLUDING "BUT NOT LIMITED TO, MEDICAL DOCTOR AND/OR HOSPITAL VISITS. " " "2. ิHE POWER TO AUTHORIZE MEDICAL TREATMENT OR MEDICAL PROCEDURES IN "AN EMERGENCY SITUATION. " " "3. ิHE POWER TO MAKE APPROPRIATE DECISIONS REGARDING CLOTHING, "BODILY NOURISHMENT, AND SHELTER. " " "ำIGNED ON THIS \T DAY OF \U, \V. " " " " "คคคคคคคคคคคคคคคคคคคคคคคคคคคคคค คคคคคคคคคคคคคคคคคคคคคคคคคคคคคค " PARENT(S) " " "ำิมิล/รฯออฯฮืลมฬิศ ฯฦ คคคคคคคคคค " " "รฯีฮิู/ยฯาฯีวศ/ะมาษำศ ฯฦ คคคคคคคคคค " " "ยลฦฯาล อล, THE UNDERSIGNED AUTHORITY, ON THIS DAY PERSONALLY APPEARED "\A, KNOWN TO ME TO BE THE PERSON(S) WHOSE NAME(S) IS(ARE) SUBSCRIBED "TO THE FOREGOING INSTRUMENT, AND ACKNOWLEDGED TO ME THAT HE(SHE)(THEY) "EXECUTED SAID INSTRUMENT FOR THE PURPOSES AND CONSIDERATION THEREIN "EXPRESSED. " " "วษึลฮ UNDER MY HAND AND SEAL OF OFFICE ON THIS คคคคคคคคคค "DAY OF คคคคคคคคคค, คคคคค. " " " " "คคคคคคคคคคคคคคคคคคคคคคคคค " " "ฮOTARY ะUBLIC'S ำIGNATURE " " "(SEAL/STAMP) " " " " "