Florida Power of Attorney for a Child
This Power of Attorney (POA) document is made in accordance with the laws of the State of Florida. It authorizes the designated individual to make decisions regarding the welfare and care of the child named below.
Principal's Information:
- Full Name: ______________________________________
- Date of Birth: ____________________________________
- Address: _________________________________________
- City, State, Zip: _______________________________
- Phone Number: ___________________________________
Child's Information:
- Full Name: ______________________________________
- Date of Birth: ____________________________________
- Address: _________________________________________
- City, State, Zip: _______________________________
Agent's Information:
- Full Name: ______________________________________
- Relation to Child: _________________________________
- Address: _________________________________________
- City, State, Zip: _______________________________
- Phone Number: ___________________________________
Powers Granted:
The Principal grants the Agent the authority to:
- Make decisions regarding the child’s education.
- Permanent and temporary custodial care and supervision.
- Access medical records and make health care decisions.
- Provide transportation for the child.
This Power of Attorney becomes effective on the date signed below and will continue until revoked in writing or the child reaches the age of majority, unless a specific expiration date is provided:
Effective Date: ________________________________
IN WITNESS WHEREOF, I have executed this Power of Attorney for a Child on this ____ day of _____________, 20__.
Principal's Signature: _____________________________
Witness 1 Signature: _____________________________
Print Name: ______________________________________
Witness 2 Signature: _____________________________
Print Name: ______________________________________
Notary Public:
State of Florida
County of ______________________
On this ____ day of _____________, 20__, before me personally appeared _______________ (Principal's name), known to me to be the person described in this document, and acknowledged that they executed it for the purposes therein contained.
Notary Public Signature: _____________________________
My Commission Expires: ________________________________