Homepage Fill Out Your Da 5841 R Form
Article Structure

The DA Form 5841 is an essential document for individuals in the military who need to designate someone to care for their children during their absence. This special power of attorney, often referred to as a POA, allows parents to appoint a trusted individual, known as the attorney-in-fact, to manage various responsibilities related to their child's well-being. It is critical to understand that while there is no obligation to use the DA Form 5841 as part of your Family Care Plan, it provides a structured way to ensure your children's needs are met when you cannot be there. The form grants the designated person the authority to handle decisions around medical care, education, and daily living necessities, empowering them to act in the child's best interests. However, it's important to note that the effectiveness of this power of attorney can vary depending on local laws and situations. Consequently, parents are encouraged to seek legal guidance to ensure the document meets specific needs. Certain parties, such as doctors and school officials, should be familiar with the form, as their willingness to recognize it can significantly impact its intended use. Additionally, while the DA Form 5841 is a legal instrument, it does not prevent other relatives, including non-custodial parents, from pursuing custody of the children in court if they choose to do so.

Da 5841 R Example

SPECIAL INSTRUCTIONS RELATED TO EXECUTION OF POWERS OF ATTORNEY

The DA Form 5841 is a special power of attorney (POA) that may be used to authorize a person to take care

of your child(ren) in your absence. It is important that you understand that you are not required to use this POA for your Family Care Plan. You may seek legal assistance to have a different POA drafted that better provides for your family members if you so desire. You must also understand that depending on the law or other requirements where your child (ren) will be living, a POA may not always be effective for your designated guardian to care for your child (ren) under any or all

circumstances. You may seek legal assistance to advise you about the effectiveness of DA Form 5841, other POAs or any other matters in your Family Care Plan.

It is very important that the following persons be shown the POA or other appropriate documentation for the purpose of determining whether they will honor it:

Doctors, dentists, and hospital officials or other health care providers who may be called upon to treat your child (ren).

Any school officials or other officials who may need your permission to provide services for your child (ren) or register your child (ren) in school.

If the persons identified above will not honor the POA, you must ask to be provided powers of attorney or other documents that will be honored. You should show this POA or other documentation to all facilities, institutions, and individuals to ensure they will recognize it for the purposes you have intended.

You must understand that a POA will not prevent another person, such as a non-custodial parent or relative of your child (ren), from petitioning a court of competent jurisdiction to obtain temporary or permanent custody of your children

DA FORM 5841, DEC 2005

APD PE v1.01

POWER OF ATTORNEY

For use of this form, see AR 600-20; the proponent agency is DCS, G-1.

PRIVACY ACT STATEMENT

AUTHORITY:10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.

PRINCIPAL PURPOSE: To designate a guardian to care for your child (ren) in your absence.

ROUTINE USES:

None.

DISCLOSURE:Mandatory; failure to maintain a Family Care Plan could subject you to separation, administrative action, or. disciplinary action under the UCMJ.

KNOW ALL PERSONS BY THESE PRESENTS:

That I,

, Social Security Number

 

 

, of the state of

 

 

, a

member of the United States Armed Forces, currently residing in

, pursuant to Military Orders, do hereby appoint , presently residing at

, my true and lawful attorney-in-fact to do the

following acts or things in my name and in my behalf: To assume and maintain guardianship of my child (ren),

;

to do all acts necessary or desirable for maintaining health, education, and welfare; and to maintain customary living standards, including, but not limited to, provision of living quarters, food, clothing, medical, surgical and dental care, entertainment and other customary matters; and, specifically, to approve and authorize any and all medical treatment deemed necessary by a duly licensed physician and to execute any consent, release or waiver of liability required by medical or dental authorities incident to the provision of medical, surgical or dental care to any of them by qualified medical or dental personnel.

I hereby give and grant individually unto my said attorney full power and authority to do and perform all and any act, deed, matter and thing whatsoever in and about any of the aforementioned specified particulars as fully and effectually to all intents and purposes as I might and could do in my own person if personally present; and in addition thereto. I do hereby ratify and confirm each of the acts of my aforesaid attorneys lawfully done pursuant to the authority herein above conferred.

I HEREBY AUTHORIZED MY ATTORNEY TO INDEMNIFY AND HOLD HARMLESS ANY THIRD PARTY WHO ACCEPTS AND ACTS UNDER OR IN ACCORDANCE WITH THIS POWER OF ATTORNEY.

I intend for this to be a DURABLE Power of Attorney. This Power of Attorney will continue to be effective if I become disabled, incapacitated, or incompetent.

I authorize by attorney-in-fact to hire legal counsel in order to carry out the provisions of this document or determine the existence of legal requirements, such as required filing or placement of notices, which may affect the validity of this document.

DA FORM 5841, DEC 2005

DA FORM 5841-R, APR 99 IS OBSOLETE.

APD PE v1.01

I HEREBY RATIFY ALL THAT MY ATTORNEY SHALL LAWFULLY DO OR CAUSE TO BE DONE BY THIS DOCUMENT.

This Power of Attorney shall become effective when I sign and execute it below. Further, unless sooner revoked or terminated by me, this Power of Attorney shall become NULL and VOID on

.

Notwithstanding my inclusion of a specific expiration date herein, if on the above-specified expiration date,

or during the sixty (60) day period preceding that specified expiration date, I should be or have been determined by the United States Government to be in a military status of "missing," "missing in action," or "prisoner of war," then this Power of Attorney shall remain valid and in full effect until sixty (60) days after I have returned to United States military control following termination of such status UNLESS OTHERWISE REVOKED OR TERMINATED BY ME.

IN WITNESS WHEREOF, I sign, seal, declare, publish, make and constitute this as and for my Power of

 

 

Attorney in the presence of the Notary Public witnessing it at my request this date

 

,

 

State of

 

, County of

 

 

.

 

 

 

 

I, the undersigned, certify that I am a fully commissioned, qualified, and authorized notary public. Before

,

me personally, within the territorial limits of my warrant of authority, appeared

, who is known by me to be the person who is

described herein, whose name is subscribed to, and who signed the Power of Attorney as grantor, and who, having been duly sworn, acknowledged that this instrument was executed after its contents were read and duly explained, and that such execution was a free and voluntary act and deed for the uses and purposes herein set forth.

IN WITNESS WHEREOF, i have hereunto set my hand and affix my seal this

 

day

of

 

,

 

 

 

 

GRANTOR'S SIGNATURE

 

 

 

 

ACKNOWLEDGMENT

 

 

 

 

 

 

STATE OF

 

 

 

 

COUNTY OF

 

 

 

 

Acknowledged before me this

 

day of

,

 

.

 

 

 

 

(Notary Public)

My commission expires:

PAGE 2, DA FORM 5841, DEC 2005

APD PE v1.01

Form Characteristics

Fact Name Fact Description
Purpose The DA Form 5841 is designed to establish a power of attorney for the care of a child or children in the absence of their parent or legal guardian.
Types of Authority This form allows the appointed attorney-in-fact to manage various aspects of the child's life, including healthcare, education, and general welfare.
Durability The power of attorney created by this form remains effective even if the parent becomes disabled, incapacitated, or incompetent.
Governing Law The use of this form is governed by Army Regulation 600-20, which pertains to Army command policy.
Notification Requirement Individuals and entities such as doctors, schools, and other officials should be shown the form to ensure they will honor it.
Expiration This power of attorney can have a specific expiration date, but may remain valid under certain military conditions, such as being declared missing in action.
Legal Advice It is advisable to seek legal assistance if a different power of attorney is preferred or if there are concerns about the form’s effectiveness.
Mandatory Disclosure Disclosure of this power of attorney is mandatory, and failure to maintain a Family Care Plan may lead to administrative actions.
Indemnification Clause The form allows the attorney-in-fact to indemnify third parties who accept and act upon the powers granted.
Versioning The current version of the DA Form 5841 was updated in December 2005, with prior versions considered obsolete.

Guidelines on Utilizing Da 5841 R

When preparing to fill out the DA 5841 R form, it's essential to gather some necessary personal information. This information will help ensure everything is accurate and complete, facilitating the successful designation of guardianship for your child or children during your absence. Below are the steps that will guide you through the completion of the form.

  1. Locate the Form: Obtain the DA 5841 R form, which can be found online or through military legal assistance offices.
  2. Read the Instructions: Before filling it out, carefully read the special instructions section to understand the implications of granting power of attorney.
  3. Fill in Your Personal Information: Enter your name, Social Security number, and state of residency in the designated areas of the form.
  4. Indicate Military Status: Provide information regarding your military status, including any relevant orders.
  5. Name Your Attorney-in-Fact: Clearly state the name and address of the individual you are appointing as your attorney-in-fact, who will care for your child or children.
  6. Specify Guardianship Powers: In the appropriate sections, outline the specific responsibilities and authorities you grant to the attorney-in-fact.
  7. Include Medical Authorization: Make sure to authorize your attorney-in-fact to make medical decisions on behalf of your child or children, if necessary.
  8. Set Expiration Date: If applicable, enter an expiration date for the power of attorney, keeping in mind that conditions may allow it to remain valid longer under specific circumstances.
  9. Sign and Date the Form: Sign the document in the designated area and provide the date of signing.
  10. Notarization: Have the document notarized to ensure its legal validity. Ensure the notary fills out their section, verifying your identity and the legitimacy of the signing.

What You Should Know About This Form

What is the DA Form 5841 and what is its purpose?

The DA Form 5841 is a special power of attorney designed to allow someone to take care of your child or children when you are not able to do so. By completing this form, you name a trusted individual to act on your behalf regarding your child's well-being, including decisions about health care and educational needs. This form is particularly useful for military personnel who may need to be away from home for extended periods.

Do I need to use the DA Form 5841 as part of my Family Care Plan?

No, you are not required to use the DA Form 5841 as part of your Family Care Plan. While it serves as an effective tool for granting guardianship, you have the option to seek legal assistance to create a different power of attorney that may better suit your particular family situation. It's important to choose the document that best meets your needs.

Will the DA Form 5841 be honored by all necessary parties?

Not necessarily. Although the DA Form 5841 is a legal document, some doctors, schools, or other officials may not recognize it without additional verification. It is crucial to show this power of attorney to healthcare providers, educators, and other relevant authorities beforehand to ensure they will honor it. If they refuse to accept it, you may need to obtain another type of power of attorney that they will recognize.

What happens if someone petitions for custody of my children while I have a DA Form 5841 in effect?

The DA Form 5841 does not prevent other individuals, such as a non-custodial parent or relative, from seeking legal custody of your child or children. In such cases, the form alone does not provide immunity against court action. If someone pursues custody, the court will ultimately determine custody arrangements based on various factors, including the best interests of the child.

Common mistakes

Filling out the DA 5841 R form is a crucial step for service members who need to appoint a guardian for their children while they are absent. Yet, many people make common mistakes that can lead to complications or even invalidation of the document. Understanding these potential pitfalls is essential.

One significant error occurs when individuals fail to provide complete and accurate information about themselves and their appointed attorney-in-fact. Missing details such as the full name, current address, or social security number can create confusion, and the form may be rejected. Ensure all sections are filled out completely to avoid any issues.

Another common mistake is neglecting the signature requirement. Some may think that signing at the end is sufficient. However, the document must be signed in front of a notary public to ensure its validity. Failing to follow this step can render the power of attorney ineffective.

People often overlook the importance of specifying the duration of the power of attorney. If an expiration date is not provided, the PA may be considered indefinite. Conversely, an unrealistic expiration date might lead to premature termination of the authorization. Clarity regarding the effective dates is essential to avoid unintended consequences.

Furthermore, it's critical to understand that not all states or institutions may honor the DA 5841 form as a valid power of attorney. Individuals frequently make the mistake of assuming that the document will be recognized everywhere. Consulting with legal counsel beforehand can help ensure that the form meets all local requirements.

Another issue is failing to communicate the existence of the DA 5841 to all relevant parties. Guardians, healthcare providers, and school officials must be informed and shown the power of attorney. If they are unaware of it, they may not accept its authority, leading to complications in emergency situations.

Inappropriate granting of powers can also trigger problems. While it’s tempting to provide wide-ranging authority to the attorney-in-fact, individuals should closely consider the specific acts they wish to perform. Vague language or all-encompassing permissions could lead to misuse of the power granted, which can have serious repercussions.

Additionally, people might not give enough thought to their choice of attorney-in-fact. Selecting someone who is untrustworthy or lacks the ability to act in the best interests of the children can lead to conflicts. Careful consideration of this decision is paramount for the wellbeing of the children.

Lastly, failure to review the completed form can lead to minor errors that create big problems. Typos or incorrect information might seem insignificant at first glance, but they can derail the entire process. A thorough review is a simple yet effective step to ensure that the document is completed correctly.

Recognizing and avoiding these mistakes when filling out the DA 5841 R form is vital. Take the time to ensure that everything is correct and that all parties involved are informed. Doing so will protect the interests and well-being of your children while you are away.

Documents used along the form

When families and individuals in the military find themselves needing to designate guardians for their children in their absence, they often utilize the DA Form 5841. Accompanying this document, several other forms and documents may be needed to ensure all legal bases are covered. Understanding these related documents can facilitate smoother interactions among healthcare providers, schools, and guardians. Below is a list of some commonly associated forms that may enhance the utility of the DA Form 5841.

  • DA Form 5840: This is the Power of Attorney for Child Care, which provides a more generalized authority to care for children. It allows an appointed individual to manage a child's day-to-day needs without the more specific limitations placed by DA Form 5841.
  • DA Form 7266: This form serves as a certification of guardianship, often required in legal proceedings. It provides evidence that the guardian has been officially designated and can be presented to courts or institutions to confirm the guardian's authority.
  • DA Form 1602: This document outlines the military member's Family Care Plan. It ensures that all aspects of caregiving, including alternative childcare arrangements, are thoroughly documented and easily accessible.
  • State Power of Attorney Form: Each state may have its own version of a Power of Attorney form. This state-specific document may be needed to support or supplement the DA Form 5841, depending on local laws and requirements.
  • Medical Consent Form: This form allows caregivers to consent to medical treatment on behalf of the child. It is essential for ensuring that the guardian can act in a medical emergency without hesitation.
  • School Registration Forms: These documents may be required for enrolling a child in school. They often need the signature or consent of a legal guardian, making it crucial that the appointed guardian has the authority recognized by the school.

Understanding the various forms related to the DA Form 5841 is vital for military families. These documents serve as critical tools in securing the well-being of children when parents are unable to provide direct care. Recognizing the importance of each form can prevent potential complications and facilitate smooth transitions during challenging times.

Similar forms

  • General Power of Attorney (GPA): This document grants broad authority to another person to act on your behalf in a variety of legal and financial matters. Unlike the DA Form 5841, a GPA is not specifically limited to guardianship over children.
  • Durable Power of Attorney: Similar to the DA Form 5841, this document remains effective even if you become incapacitated. It allows someone to make decisions for you, but it can cover more areas than just child care.
  • Medical Power of Attorney: This form allows an appointed individual to make medical decisions on your behalf if you are unable. While the DA Form 5841 includes health care decisions for children, the Medical POA focuses on the principal’s health care needs.
  • Child Care Authorization: This document specifically authorizes a person to take care of your child(ren) but may not include all the detailed powers granted in the DA Form 5841 regarding medical care and education.
  • Limited Power of Attorney: This form restricts the powers granted to specified acts or a specific period, unlike the more extensive powers typically granted by the DA Form 5841.
  • Temporary Guardianship Agreement: This is often used for short-term care arrangements for children, similar to the DA Form 5841, but it may not carry the same legal weight or duration.
  • Affidavit of Guardianship: This document expresses a person’s intention to temporarily care for a child and is more of a statement than an authorization, unlike the legal authority provided by the DA Form 5841.
  • Consent for Medical Treatment: This document allows a temporary guardian to consent to medical treatment for your child(ren). While the DA Form 5841 provides similar authority, this document is more focused specifically on medical care.

Dos and Don'ts

When filling out the DA Form 5841 R, keep these important dos and don'ts in mind.

  • Do ensure all personal information is accurate and complete.
  • Do consult legal assistance if you have questions about the power of attorney.
  • Do inform the designated guardian about their responsibilities outlined in the document.
  • Don't assume the power of attorney will be honored everywhere without prior confirmation.
  • Don't neglect to show the document to health care and educational officials who may need to recognize it.
  • Don't overlook the need to periodically review and update the document as circumstances change.

Misconceptions

Misconceptions about the DA Form 5841 R can lead to confusion and potentially unintended consequences. Here are eight common misconceptions clarified:

  • The DA Form 5841 R is mandatory for all service members. This form is not required for every service member's Family Care Plan. Alternatives to this specific power of attorney may be more appropriate depending on individual circumstances.
  • Using the DA Form 5841 R guarantees that all third parties will recognize it. Recognition of the form is not guaranteed. Individuals must present the form to relevant authorities, such as healthcare providers and schools, to ensure they will honor it.
  • This form allows unlimited authority to the appointed attorney-in-fact. While the DA Form 5841 grants significant powers, its scope can be limited by specific instructions from the person executing the document.
  • The power of attorney remains effective indefinitely. This document has an expiration date set by the individual. Additionally, it may become void if the granter is determined to be missing in action or imprisoned.
  • Once signed, the DA Form 5841 cannot be revoked. A service member retains the right to revoke the power of attorney at any time, as long as they follow the necessary procedures for cancellation.
  • Using this form means the appointed guardian holds custody of the children. The DA Form 5841 does not confer custody rights. It only grants authority to make decisions in the absence of the parent or guardian.
  • Legal assistance is unnecessary when using this form. It is advisable to seek legal counsel to ensure the effectiveness of the document and its compliance with state regulations.
  • The form applies uniformly across all states. Legal recognition of the DA Form 5841 may vary by state. Local laws can affect how it is accepted and enforced regarding guardianship and medical decisions.

Key takeaways

Filling out the DA Form 5841 R is vital for parents in the military who need someone to care for their children during their absence. Here are key takeaways to consider when using this power of attorney form:

  1. The DA Form 5841 R is designed to appoint a temporary guardian for your child or children when you are unavailable.
  2. You are not obligated to use this specific power of attorney for your Family Care Plan; alternatives may be more appropriate.
  3. Seek legal advice to ensure that the DA Form 5841 R meets your family's needs and complies with local laws.
  4. Understand that some local laws might limit the effectiveness of the power of attorney in specific situations.
  5. All parties who may need to verify the POA, including health care providers and school officials, should be informed about the document.
  6. If a doctor, school, or institution does not recognize the DA Form 5841 R, look for other legal documents that might be accepted.
  7. This power of attorney does not prevent other individuals from seeking legal custody; be aware of this risk.
  8. Once signed, the POA becomes effective, but can be revoked at any time before its expiration date.
  9. The DA Form 5841 R remains valid even if you become incapacitated unless revoked.
  10. Consult a notary public to finalize the form, as notarization is necessary for it to be legally recognized.

These points provide a concise overview of the considerations and requirements associated with the DA Form 5841 R. Always prioritize understanding the implications of your choices as a guardian for your children.