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Missouri Minor Child (Parental) Power of Attorney Form

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Missouri Minor Child (Parental) Power of Attorney Form can be used by parents who want to make sure there is someone they approve to take care of their child if and when they are going to be unavailable. This allows a caretaker the power to make decisions related to health care and education of the child when the parents are unavailable to make those decisions. The form remains valid for a period of one (1) year.

Laws§ 475.604

Maximum Time-Period (§ 475.602) – One (1) year.

Medical Decisions Only – If the parent(s) would like to grant decision-making abilities directly related to health care.

How to Write

1 – The Form Required To Designate A Guardian Powers Is Available To Open Here

You may use any of the buttons below the image on the right to access this form. Make sure that you have compatible software for the file type you have chosen (PDF, Word, or ODT)

2 – Name The Minor This Form Will Focus On

In Article I, enter the Full Name of the Minor or Child who the Attorney-in-Fact will be granted Principal Guardian Power over on the first blank line displayed.

Next, record the Calendar Day of the child’s Birthday (1-31) on the blank space between the words “…Born On The” and “Day Of.” Follow this up by entering the Month of the Child’s Birth Date on the next blank space and the Year when the Child was born.

3 – Submit Information Defining The Parent/Guardian Issuing This Order

The next two statements are nearly identical but will require unique information. Each one has been provided so that a Parent or Current Guardian has his or her information recorded in a unique area. If only one Parent or Current Guardian has Principal Power over the child, only one of these statements will require attention (the other may be left blank).

The first blank space in each Statement should have the Name of the Principal or Guardian issuing Guardian Powers entered on it. After entering the Name of the Parent or Guardian, mark the checkbox labeled “Parent” or “Court Appointed Guardian” to indicate the role the Principal plays in the Child’s (or Minor’s) life.

Lastly, you must document the Parent or Current Guardian’s Full Residential Address using the next three blank spaces. Utilize the space after the words “…street address of” to document the Building Number, Street/Ave/Road Name, and any applicable Unit Number where the Parent or Current Guardian lives. Continue the Address report by entering the City and State where the Parent or Guardian lives on the next two blank spaces in that order.

4 – Declare The Attorney-in-Fact With Principal Guardian Authority

Now, locate Article II. Use the blank space after the words “I/We hereby appoint” to record the Full Name of the individual being appointed with Guardian Powers over the Child as the Attorney-in-Fact. The second blank space will need to have the type of relationship the Attorney-in-Fact holds with the Child or Minor reported. Finally, we will use the next three empty spaces to document the Street Address, City, and State where the Attorney-in-Fact assuming Guardian Powers lives.

5 – Delegate Principal Guardian Powers Being Granted

In Article III, we will discuss the extent of the Guardian Powers being assigned to the Attorney-in-Fact here. The Principal Parent will need to initial the blank space next to the statement that accurately defines the extent of Guardian Powers being granted then, mark the checkbox.

If the Principal is appointing All of his or her Parental Authority to the Attorney-in-Fact, then he or she must initial the blank space between the letter “A” and the checkbox then, mark the checkbox. If the Principal is designating only some of his or her Parental Authority to the Attorney-in-Fact, then he or she must initial the blank line between the letter “B” and the checkbox. The Principal must also mark the checkbox and define the Principal Actions and Decisions the Attorney-in-Fact may engage in, with Principal Authority, on the blank lines provided.

Before we finalize this form, we will also need to define its lifespan. This will be done in Article IV. Here the Principal Parent may select any two Dates, within One Year of each other, to define when the Attorney-in-Fact may use Principal Guardian Powers and when the Attorney-in-Fact may no longer use Principal Guardian Powers over the minor. Enter the Calendar Day, Month, and Year of the first day the Attorney-in-Fact will act as a Guardian on the first three blank spaces in the statement provided.

Use the last three spaces to record the Calendar Day, Month, and Year when the Attorney-in-Fact’s Principal Guardian Powers terminate or end.

6 – All Required Signature Parties Must Participate In This Form’s Execution

In Article V each of the Child’s Parent’s (or Guardians) must Sign his or her Name on the blank line labeled “Parent/Court Appointed Guardian Signature,” Print his or her Name on the “Print Name” line, and enter the Signature Date when he or she provided these items on the “Date” line. The “Acceptance By Attorney-in-Fact” requires the Attorney-in-Fact’s Signature, Printed Name, and Signature Date provided on the blank spaces labeled “Attorney-in-Fact’s Signature,” “Print Name,” and “Date.” Next, in “Affirmation By Witness 1” and “Affirmation By Witness 2,” each Witness must select a paragraph then enter his or her Name into the statement he or she will sign. Once this is done the Signature Witness must sign the blank line labeled “Witness 1 Signature” (or “Witness 2 Signature”), then Print his or her Name directly below the Signature. Each Signature must have the Date it was provided displayed on the blank line labeled “Date.”

The Notary Public overseeing this Guardian appointment is the only entity that can notarize this document in the “Notary Acknowledgement” section. Make sure all the information requested here is supplied after the Notarization process is completed.


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