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Connecticut Parental (Minor Children) Power of Attorney Form

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Connecticut Parental (Minor Children) Power of Attorney Form

Updated June 06, 2023

A Connecticut parental (minor children) power of attorney gives an individual the right and powers to act as a child’s guardian in places of their actual legal parent or guardian. Once it is completed, this form allows the appointed person to act on behalf of the issuing parent, in matters relating to the children. This will enable the caretaker to be delegated such power to perform actions such as making healthcare decisions, financial decisions, and education decisions. This type of form is helpful if you’re leaving on a vacation without the children or are in the military and being deployed. The designation allows for the standby guardian to be in effect for a period no longer than one (1) year.

Application/Appointment of Temporary Guardian (Form PC-504) – May be used when petitioning the court due to a parent being incompetent or in military service.

How to Write

1 – Designate A Temporary Guardian Using The Template On This Page

Download the form through the buttons displayed on this page below the file image. It should be noted this template has two parts each of which must be signed at different times. The first part can be prepared immediately and signed at your discretion. The second part should only be filled out, by the Standby Guardian, when it is time for him or her to assume principal parental powers over the Minor(s) named in this document.

2 – Familiarize Yourself With The Disclosure

The first page is titled “Information And Instructions Designation Of A Standby Guardian Of A Minor C.G.S. Sections 45a-624 To 624g.” Read each point on this page as it will provide you with some valuable information.

3 – Identity Each Party Concerned With This Document

If you have a crystal clear understanding of the information on the first page, then it will be time to supply this form with the items it requests. Begin by documenting the full name of the Parent or Court-Appointed Guardian on the first blank line. If there are two Parents or Court-Appointed(s) who holds custody over the Minor, then report the name of each one on this line. Continue providing this form with information by entering the “Street Address” and “City, State, Zip Code” where the Parent or Guardian you presented above lives across the next two blank spaces. If two Parents who live in separate residences share custody of the Minor then produce a separate signed form for each Parent or Guardian. Next, you will need to record the full name of the individual you intend to name as the Standby Guardian of the Minor(s). A blank space labeled “Name Of Standby Guardian” has been included in this statement for this purpose. In addition to the Standby Guardian’s name, present his or her residential address by supplying its building number, street name, and apartment number (if applicable) on the blank space “Street Address” along with the intended Standby Guardian’s city, state, and zip code on the next blank space. Once we have documented the name of the Principal Guardian or Parent and have identified the intended Standby Guardian, this paperwork will require positive identification of the Minor whom the Standby Guardian will be responsible for. Utilize the blank line labeled “Names Of Minor Children” to list the full name of each Minor the Standby Guardian will be responsible for as per this appointment.  Locate the statement ending with the parentheses phrase “Insert Specific Contingency Or Contingencies” The space beneath it has been provided so that you may record the catalyst or date when you wish the parental power over the child be granted to the Standby Guardian to go into effect. For instance, you may declare a specific time frame when the Standby Guardian will be responsible for the Minor or the details of an event. If you do not specify how or when the powers granted to the Standby Guardian end, they will naturally terminate one year after they go in effect if both the Parents are alive or 90 days after the death of the issuing.

4 – A Notarized And Witnessed Signature Of The Parents Must Be Delivered

This declaration of parental power must be associated with a definitive signature date. Enter the date when the parties listed as the Parent or COurt-Appointed Guardians physically sign their names on this paperwork on the first blank space labeled “Date” after the term “…While I Am Sound Mind.” Each Parent or Guardian must sign the blank line labeled “Signature Of Parent.” Notice that two separate signature areas have been supplied to this area in case there are two Parents or Court-Appointed Guardians. If this is the case, each one should sign a separate area and each signature must be authenticated through the Witness’s signature.

Once the Parent or Court-Appointed Guardian has signed this document, he or she must present his or her printed name on the blank line labeled “Type Or Print Name Of Parent.” Two Witnesses must observe each signing of this paperwork. In turn, each Witness must sign this document to verify the authenticity of the Parent/Guardian and Standby Guardian signatures. Thus, once you have signed this document relinquish it to the Witnesses present. Each one must sign the “Signature Of Witness” line, print his or her name on the “Type Or Print Name Of Witness” line then record his or her address on the “Street Address Of Witness” and “City, State And Zip Code Of Witness” line.  The next section has been supplied in case there are two Parents or Court-Appointed Guardians. In this case, the second Parent/Court-Appointed Guardian must satisfy the same requirement as the first. He or she must provide a witnessed signature. The next section is only required if the principal parental powers are being delegated by one or more Court-Appointed Guardians. If this is the case, then the Standby Guardian must supply a witnessed signature to solidify his or her acknowledgment and acceptance of principal power. The area just under the bold words “Statement That Designation Of Standby Guardian Is In Full Force And Effect” will require attention only at the time the conditions causing the powers in this document to become active have occurred. Notice the top portion of this page. This area will require the work of a notary public. This page must be prepared with the names and addresses of the Parent(s) placed on the first three blank spaces along with the name(s) and addresses(es) of the Standby Guardian(s) on the next three blank lines.

The next two blank spaces, labeled “Date Of Designation,” must have the exact calendar date when the Standby Guardian assumes principal parental powers over the Minor(s) listed above. 

Next, record the full name of the Minor that the Standby Guardian will assume principal parental powers over on the blank line labeled “Names Of Minor Children.” The blank space beneath the words “That Specified Contingency Was” must be populated with the reason why the Standby Guardian is assuming principal parental powers over the child. This area of the document must be signed by the Standby Guardian and two Witnesses. The Standby Guardian must enter the current calendar date on the blank line labeled “Date” after below the “In Witness Whereof” statement. The Standby Guardian must sign the “Signature Of Standby Guardian” line as a testimony that he or she will assume responsibility for the welfare of the Minor(s) listed above because the contingency the Parent(s)/Court-Appointed Guardian(s) have occurred. Two distinct areas beginning with a “Signature Of Witness” line have been provided. Each Witness to the Standby Guardian’s act of signing must sign his or her name to this line then print his or her name and address just below it.


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