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Illinois Power of Attorney for Minor Child Form

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Illinois Power of Attorney for Minor Child Form

Updated June 06, 2023

An Illinois power of attorney for a minor child is a template that allows parents to delegate temporary guardianship status on another person to care for their child(ren) in the event they are unable to. For instance, if the parent is deployed by the military or ill. It will allow your agent to make financial, educational, and medical decisions on behalf of your child(ren) if you can’t be reached.

How to Write

1 – Gather And Review All Supporting Information Then Download The Form On This Page

Some background information regarding the Parent or current Guardian, intended Guardian, and the concerned Minor(s). Make sure all this information is easily accessible then open the form on this page (using the buttons on the right) and save it.

2 – Identify Parties This Document Will Affect

On the first line, after the words “…child is,” enter the Full Name of the Minor or Child this document concerns. This should be followed by the Minor’s Birth Date on the blank space after the words “…born on.”

In the first paragraph, after the words “(Biological Parent/Legal Guardian),” enter the full Name of the Parent or Current Legal Guardian of the Child or Minor. If there are two, then make sure both names appear on this line.

On the next blank line, enter the Full Name of the individual who shall act as a Guardian or Safe Family Parent by virtue of this form’s completion.

After this initial paragraph has been tended to, each Parent or Current Legal Guardian must initial a unique blank line provided (after the phrase “Biological Parent/Legal Guardian”).


All the Signature Parties should carefully read Section A through Section D. In Section E, any applicable Medicaid or Health Insurance Card Numbers used to pay for the Minor’s Health Care should be reported on the blank line(s) labeled “Applicable card numbers and providers.” Additionally, the biological Parent/Legal Guardian should sign the blank line following the words “I/we agree to pay uncovered charges” and provide the Date of this Signature.

In Section 2, each Parent or Legal Guardian should initial the blank spaces provided to agree with the statement above it. This will grant approval in making decisions regarding extreme medical circumstances.

Section 3 will state the Parent or Guardian’s desire to prolong the Minor’s life (unless in a coma) and should be initialed if the Parent or Current Guardian agrees with it.

Enter the exact Date when the Authority defined in this Power of Attorney will become effective on the blank line in Section 4.

Enter the exact Date when this Power of Attorney’s Effectiveness will terminate on the blank line in Section 5. In Section 6, enter the Full Name of the Agent on the blank line.

3 – A Valid Signature Of The Parent/Current Guardian Is Required

Next, in Section 9, each Biological Parent or Current Guardian must Sign his or her Name and enter the Date of Signature beside it.

Below the Parent/Current Guardian Signature will be a line labeled “Witnesses.” Here, the individual who has witnessed the Parent/Current Guardian Signing must sign his or her name then provide the Date of Signature.

If a copy of this document has been submitted to the Biological Parent/Legal Guardian, Safe Family Parents, and placed in the Lydia/Safe Family Parent file then check the box preceding the last sentence on this form.

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