New York Power of Attorney for a Child
This document grants authority to a designated individual to act on behalf of the child named below, in accordance with New York State laws regarding powers of attorney for minors.
Parent/Guardian Information:
- Full Name: ___________________________
- Address: ____________________________
- City, State, Zip: _____________________
- Phone Number: ________________________
- Email Address: ______________________
Child Information:
- Full Name: ___________________________
- Date of Birth: ________________________
- Address: ____________________________
- City, State, Zip: _____________________
Agent Information:
- Full Name: ___________________________
- Address: ____________________________
- City, State, Zip: _____________________
- Phone Number: ________________________
- Email Address: ______________________
Duration of Power of Attorney:
- This Power of Attorney shall remain in effect until: ___________________
This document is intended to grant the Agent the legal authority to make decisions regarding the care, custody, and welfare of the child, including:
- Access to medical care and treatment.
- Enrollment in school, daycare, or extracurricular activities.
- Making decisions about travel and temporary relocation.
By signing this document, I acknowledge my understanding of its contents and give my consent for the aforementioned individual to act on behalf of my child.
Parent/Guardian Signature: ________________________________
Date: ___________________________
Witness Signature: ________________________________
Date: ___________________________