New York Power of Attorney for a Child
This Power of Attorney for a Child is created in accordance with New York State laws. This document allows a designated individual to make decisions on behalf of your child when you are unable to do so.
Principal Information:
- Full Name of Parent/Guardian: ______________________
- Address: ________________________________________
- Phone Number: ________________________________
- Email: ________________________________________
Child Information:
- Full Name of Child: ____________________________
- Date of Birth: __________________________________
- Address: ________________________________________
Agent Information:
- Full Name of Agent: ____________________________
- Relationship to Child: _________________________
- Address: ________________________________________
- Phone Number: ________________________________
Powers Granted:
The undersigned grants the designated Agent the authority to act on behalf of the child with respect to the following matters:
- Medical and dental care
- Educational decisions
- Travel and transportation
- General welfare
Effective Date: This Power of Attorney will become effective on the following date: ____________.
Duration: This Power of Attorney shall remain in effect until: ____________.
Signature of Parent/Guardian:
_______________________________
Date: ________________________________
Witness Information:
_______________________________
Date: ________________________________
Notarization:
State of New York
County of ___________________
On this _____ day of ____________, 20___, before me personally appeared ____________________, known to me to be the individual described in, and who executed, the foregoing instrument, and acknowledged to me that he/she executed the same.
_______________________________
Notary Public