Power of Attorney Delegating Limited Parental Powers for Visitation

I, ______________________________, of , am
(Name of affiant) (City) (State)
The natural (mother or father) of the following minor child/children:
(Circle one)
born on / / ,
born on / / ,
born on / / ,
born on / / ,
Pursuant to Idaho Code, section 15-5-104, I do hereby appoint
(Enter name of person or agent)
of , , my true and lawful attorney in fact, to act
(City) (State)
on my behalf and escort the above named minor child/children to visit (Enter name of the resident)
at an Idaho Department of Correction (IDOC) facility.

This power of attorney is given for vesting temporary custody of said child/children in
and delegating my parental powers during the period
(Enter name of person or agent)
he/she has temporary custody.

The powers granted will commence and be in force and effect beginning the day of
, 20 , and will remain in force and effect until the day of
, 20 , unless I revoke said power at an earlier date. I reserve the right to revoke this power and delegation at any time.

Dated this day of , 20

(Custodial parent or legal guardian’s signature)
Notary Section
State of
County of
On this day of , 20 , personally appeared before me
, known to me to be the person whose name is subscribed to the
(Name of affiant)
foregoing instrument, and swore and acknowledged to me that he executed the same for the purpose and in the capacity therein expressed, and that the statements contained therein are
true and correct.

Notary Public for Idaho
Residing at , Idaho
My Commission expires: