Pennsylvania Power of Attorney for a Child
This document serves as a Power of Attorney for a Child under Pennsylvania law. It allows a parent or legal guardian to authorize another person to make decisions about the child's care and well-being in their absence. This authorization can be temporary or for a specified duration.
Please fill in the required information as indicated in the blanks provided. It is advisable to consult with a legal professional to ensure that your document meets your specific needs.
Instructions: Fill out the form below with accurate details pertaining to your child and the appointed agent.
1. Parent or Guardian Information:
- Name: __________________________
- Address: __________________________
- City: __________________________
- State: __________________________
- Zip Code: __________________________
- Phone Number: __________________________
- Email Address: __________________________
2. Child Information:
- Name: __________________________
- Date of Birth: __________________________
- Address (if different from above): __________________________
3. Agent Information:
- Name: __________________________
- Relationship to Child: __________________________
- Address: __________________________
- City: __________________________
- State: __________________________
- Zip Code: __________________________
- Phone Number: __________________________
- Email Address: __________________________
4. Duration of Authority:
- This Power of Attorney shall commence on: __________________________
- This Power of Attorney shall terminate on: __________________________
- It is revocable at any time by the Parent or Guardian.
By signing below, I voluntarily consent to grant the authority described in this document to the agent named above.
5. Signatures:
- Parent or Guardian's Signature: __________________________ Date: ___________
- Agent's Signature (if applicable): __________________________ Date: ___________
This Power of Attorney should be kept in a safe but accessible place. Ensure that the agent has a copy for reference when needed. It is recommended to inform trusted family members and caregivers about this arrangement.