California Power of Attorney for a Minor Child
This document allows a parent or legal guardian to designate someone else to make decisions regarding the care and welfare of their child in the State of California. This Power of Attorney is governed by California Family Code Section 6550 et seq.
Effective Date: This Power of Attorney becomes effective on the date signed and will remain in effect until revoked in writing.
Principal Information:
- Name of Parent/Guardian: ___________________________
- Address: __________________________________________
- City, State, Zip: _________________________________
- Phone Number: ____________________________________
Attorney-in-Fact Information:
- Name of Attorney-in-Fact: _________________________
- Address: _________________________________________
- City, State, Zip: _________________________________
- Phone Number: ____________________________________
Child Information:
- Name of Child: ___________________________________
- Date of Birth: ____________________________________
Authority Granted: The Attorney-in-Fact is authorized to act on behalf of the Principal regarding the following matters:
- Make decisions about the child's medical care and treatment.
- Make educational decisions, including enrollment and special services.
- Authorize any necessary emergency medical services.
- Provide for the child's personal care and maintenance.
Signature of Principal: ___________________________
Date: ________________________
Witness Statement:
We, the undersigned witnesses, certify that the Principal signed this Power of Attorney in our presence.
- Witness Name: ________________________ Signature: ___________________ Date: ____________
- Witness Name: ________________________ Signature: ___________________ Date: ____________