Pennsylvania Power of Attorney for a Child
This Power of Attorney document is governed by the laws of the Commonwealth of Pennsylvania. It allows a parent or legal guardian to designate another individual to make decisions regarding the care and well-being of their child in specific situations.
Principal Information:
Full Name of Parent/Guardian: ______________________________________
Address: ___________________________________________________________
City, State, Zip Code: ______________________________________________
Phone Number: _____________________________________________________
Child Information:
Full Name of Child: ________________________________________________
Date of Birth: ______________________________________________________
Agent Information:
Full Name of Agent: ________________________________________________
Address: ___________________________________________________________
City, State, Zip Code: ______________________________________________
Phone Number: _____________________________________________________
Effective Date:
This Power of Attorney shall become effective on: _____________________
Term of Authority:
This authority will remain in effect until: ____________________________
Powers Granted:
The agent shall have the authority to make decisions about the following:
- Medical care and treatment
- Education and school-related matters
- Travel and transportation arrangements
- Other: ____________________________________________
Signature:
Signature of Parent/Guardian: ________________________________
Date: ______________________________________________________
This document must be signed in the presence of a notary public to confirm the identity of the Principal.
Acknowledgment by Notary Public:
State of Pennsylvania
County of ______________________
On this _____ day of ____________, 20___, before me, a notary public, personally appeared ____________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
Notary Public: ___________________________
My commission expires: __________________