MINOR CHILD POWER OF ATTORNEY

Date: [EFFECTIVE DATE]

Principal: [PRINCIPAL’S NAME], of [PRINCIPAL’S ADDRESS], hereby appoint

Agent: [AGENT’S NAME], of [AGENT’S ADDRESS], as my attorney-in-fact (hereinafter referred to as “Agent”) to act on my behalf and make decisions regarding:

Minor Child: [CHILD’S NAME], born on [CHILD’S DATE OF BIRTH], during any period of my absence or incapacity.

Powers Granted: (initial all that apply)

______- Healthcare Decisions: To make medical decisions for my minor child, including but not limited to consenting to medical treatment, surgeries, medications, and accessing medical records.

______- Educational Decisions: To make decisions concerning my child’s education, including enrolling in or withdrawing from school, choosing educational programs, and consenting to educational assessments or services.

______- Financial Decisions: To manage and make decisions regarding my child’s financial affairs, including accessing and managing bank accounts, paying bills, and making financial investments on behalf of the child.

______- Travel Consent: To consent to my child traveling domestically or internationally, including granting permission for specific trips or activities.

______- Legal Decisions: To make legal decisions on behalf of my child, such as signing legal documents, entering into contracts, or initiating legal proceedings if necessary.

______- Day-to-Day Care: To make day-to-day decisions regarding my child’s care, welfare, and upbringing, including matters related to housing, nutrition, and recreational activities.

______- Other: [DESCRIBE].

Duration and Revocation: This Power of Attorney shall remain in effect for [DURATION]. I reserve the right to revoke or modify this Power of Attorney at any time, provided that such revocation or modification is communicated to my Agent in writing.

Signature and Date:

Parent/Guardian’s Signature: _____________________ Date: ______________

Witnesses:

Witness #1 Signature: _____________________ Date: ______________

Witness #2 Signature: _____________________ Date: ______________

Agent Acceptance:

I, the Agent, accept the responsibilities and duties as the attorney-in-fact for the parent/legal guardian mentioned under this Power of Attorney.

Agent Signature: _____________________ Date: ______________