Power of Attorney for a Child
This Power of Attorney document is prepared in accordance with the laws of the State of [State]. This legal form grants authority to a designated individual to make decisions on behalf of a minor child. Please fill in the blanks with the appropriate details.
Principal Information
Principal Name: ____________________________
Principal Address: _________________________
City: _______________ State: ____________ ZIP Code: ____________
Phone Number: ____________________________
Child Information
Child’s Name: ____________________________
Child’s Date of Birth: ______________________
Agent Information
Agent Name: ____________________________
Agent Address: ___________________________
City: _______________ State: ____________ ZIP Code: ____________
Phone Number: ____________________________
Authority Granted
The Agent is authorized to make decisions regarding the following:
- Medical care and treatment for the child.
- Educational decisions.
- Cultural and religious activities.
- Travel and relocation matters.
Limitations
This Power of Attorney does not authorize the Agent to:
- Change the child’s legal name.
- Make decisions regarding the child’s adoption.
- Consent to the termination of parental rights.
Duration
This Power of Attorney shall remain in effect until [Date] unless revoked in writing by the Principal.
Signature
By signing below, I affirm that I am the Principal and I understand the nature of this Power of Attorney.
Principal Signature: _______________________ Date: ________________
Witnesses
This document must be witnessed by two individuals who are not related to the Principal.
Witness 1 Name: ____________________________ Signature: _______________________ Date: ________________
Witness 2 Name: ____________________________ Signature: _______________________ Date: ________________
Notarization
State of [State]
County of [County]
On this ___ day of __________, 20__, before me, a notary public, personally appeared [Principal Name], known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed it.
Notary Public Signature: _______________________ My commission expires: ________________