Pennsylvania Power of Attorney for a Child
This legal document allows a parent or guardian in Pennsylvania to appoint another adult to make decisions regarding the care of their child. This document is governed by Pennsylvania state law and must be completed carefully to ensure it complies with local requirements.
Important: This document should only be used in Pennsylvania.
Principal's Information:
- Name: _________________________________
- Address: _______________________________
- Phone Number: _________________________
Agent's Information:
- Name: _________________________________
- Address: _______________________________
- Phone Number: _________________________
Child's Information:
- Name: _________________________________
- Date of Birth: _________________________
Duration of Power of Attorney:
This Power of Attorney will remain in effect until: _______________________________ (insert date), unless revoked earlier by the principal.
Authority Granted:
The agent will have the authority to act on behalf of the principal regarding:
- Medical decisions
- Educational decisions
- Travel arrangements
- Everyday care and supervision
Signature of Principal:
_______________________________ Date: ________________
Witness Information:
In the presence of the undersigned witness, the principal has signed this document:
- Name of Witness: _________________________
- Signature of Witness: _____________________
- Date: ____________________________________
Notary Public:
State of Pennsylvania, County of _______________
On this _____ day of ____________, 20____, before me, the undersigned notary public, personally appeared ____________________________, known to me (or satisfactorily proven) to be the above principal.
____________________________________
Notary Public
My Commission Expires: ____________