Illinois Power of Attorney for a Child
This document serves as a Power of Attorney for a child, allowing a designated individual to make decisions regarding the child's welfare in accordance with Illinois state law.
Under the Illinois Power of Attorney Act, this form can be utilized by a parent or legal guardian to grant temporary authority to another individual for the care and custody of a child. It is important to ensure that all information is filled out completely and accurately.
Parent/Guardian Information:
- Parent/Guardian Name: _____________________________
- Address: ________________________________________
- Phone Number: ___________________________________
- Email Address: ___________________________________
Child Information:
- Child's Full Name: ________________________________
- Child's Date of Birth: ____________________________
- Child's Address: __________________________________
Agent Information:
- Agent's Full Name: _______________________________
- Relation to Child: ________________________________
- Address: ________________________________________
- Phone Number: ___________________________________
Authorization:
I hereby appoint the above-named agent to act on behalf of my child for the following purposes:
- To provide for the care and custody of the child.
- To make medical decisions and obtain medical care.
- To enroll the child in school or daycare facilities.
- To execute any documents necessary for the child's care.
Effective Dates:
This Power of Attorney shall commence on: _______________ and shall remain in effect until: _______________ or until revoked in writing by me.
Signature:
_____________________________ (Parent/Guardian Signature)
Date: _______________________
Notary Public:
State of Illinois
County of ______________________
Subscribed and sworn before me this _____ day of ______________, 20____.
_____________________________
Notary Public Signature
My commission expires: _______________