Parental Consent (text)

[Page 5]

PARENTAL CONSENT
AND POWER OF ATTORNEY

STATE OF CALIFORNIA
COUNTY OF SAN FRANCISCO
UNITED STATES OF AMERICA

I, [name], hereby declare:

1. I am the natural _____ [mother or father]/legal guardian/of _____ [name of minor], a minor, born _____ [birthdate].
2. I hereby consent to said minor going to Guyana, South America, to live and be cared for there under the Guardianship or custody of _____ [name] or whomever she appoints in her place.

I hereby appoint [spaces for three names and addresses] as my attorneys-in-fact, jointly and severally, to take any and all action any of them deem fit for the welfare of said minor. By this power of attorney, I give each of the aforesaid attorneys-in-fact the right to the care, custody, supervision, and control of said minor anywhere throughout the world, and to travel anywhere with said minor throughout the world.

Executed on this [date],
197___, at ____ [location], California
SIGNED ____

[Page 6]

STATE OF CALIFORNIA
COUNTY OF SAN FRANCISCO
UNITED STATES OF AMERICA

On _____ [date], before me, the Undersigned, a Notary Public in and for said County and State, personally appeared _______[name], known to me to be the person whose name is subscribed to the within instruments and acknowledged to me that ___ executed the same.

WITNESS MY HAND AND OFFICIAL SEAL: _____

[Pages 7 and 8 are the duplicate of pages 5 and 6]

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The forms all appear in RYMUR 89-4286-B-1-a-, with the page number(s) indicated below. The names of the minors are in alphabetical order. The date of signature also appears next to the name.