DESIGNATION OF HEALTH CARE AGENT FOR MY SON
(INCLUDING PERMISSION TO TRAVEL)
I, _______________ of _______________ County, Texas hereby designate my brother and sister-in-law, _______________, to be the health care agents (referred to herein jointly as my “Health Care Agent”) for my son, _______________ (referred to herein as “my son”). In the event _______________ both die, fail to serve, or cease to serve for any reason, I hereby designate my brother and sister-in-law, _______________, to be the health care agents (referred to herein jointly as my “Health Care Agent”) for my son.
I expressly give my Health Care Agent permission and authority to make any and all health care decisions related to the welfare of my son at all times when I am absent from the City of _______________, Texas, or at any time when my son have been left in the care of my Health Care Agent. In addition, I expressly give my Health Care Agent permission to travel with my son to any location outside the City of _______________, Texas, for any reason my Health Care Agent deems necessary
The foregoing instrument was signed by _______________ in our presence, and we, the undersigned witnesses, sign our names hereunto as witnesses at Declarant’s request and in Declarant’s presence, and in the presence of each other, on _________________________, 20_.
Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.