New York Power of Attorney for a Child
This Power of Attorney is established in accordance with the laws of the State of New York.
Notice: This document allows you to appoint someone to make decisions on behalf of your child. Please ensure this document is completed carefully.
Principal Information:
- Name of Parent/Guardian: ____________
- Address: ____________
- City, State, ZIP: ____________
- Phone Number: ____________
- Email Address: ____________
Child Information:
- Name of Child: ____________
- Date of Birth: ____________
- Address: ____________
Agent Information:
- Name of Agent: ____________
- Relationship to Child: ____________
- Address: ____________
- City, State, ZIP: ____________
- Phone Number: ____________
Grant of Authority:
I, the undersigned, hereby appoint the above-named agent as my Attorney-in-Fact to act in my place to make decisions regarding my child’s welfare, including but not limited to:
- Medical care decisions
- Educational decisions
- Travel arrangements
Effective Date:
This Power of Attorney will become effective immediately and will remain in effect until revoked by me in writing.
Signatures:
Parent/Guardian Signature: ____________________ Date: ____________
Agent Signature: ____________________ Date: ____________
Notary Public:
State of New York, County of _____________
Subscribed and sworn to before me this ____ day of ____________, 20__.
Notary Public Signature: ____________________
My Commission Expires: ____________