Summer Camp 2006

POWER of ATTORNEY / PROCURATION
TO TREAT IN CASE OF MEDICAL EMERGENCY

The undersigned_______________________, ___________________________________
Name of parent Address
___________________________________________________________________(France)

who is the parent of __________________________________________________________
Name of minor child

Hereby designates___________________________________________________________,
Name(s) of attorney(s)
____________________________________________________________Michigan (USA)
Address

in fact or either of them acting separately, attorney(s) in fact for the purpose of providing care and maintenance for__________________________ and for the purpose of executing any and
Name of minor child

all authorizations required for his or her medical, dental, optical and other emergency needs.

This power of attorney is given under Section of the Michigan Estates and Protected Individuals Code and shall expire ________________________________________

Signed, _____________________________________________________________

Date, ________________________________ at _____________________________,(France)

CJNR_2006_February_ 28_Power of attorney