New York Power of Attorney for a Child
This document is designed to grant temporary authority to manage certain aspects of a child's care and wellbeing in accordance with New York State laws.
Principal (Parent or Guardian):
Name: ___________________________
Address: _________________________
City: ____________________________
State: ___________________________
Zip Code: ________________________
Agent (Temporary Caregiver):
Name: ___________________________
Address: _________________________
City: ____________________________
State: ___________________________
Zip Code: ________________________
Child Information:
Name: ___________________________
Date of Birth: ___________________
Powers Granted:
- To provide care and supervision for the child.
- To authorize medical treatment for the child if necessary.
- To manage educational arrangements for the child.
- To make emergency decisions regarding the child's welfare.
Duration of Authority:
This Power of Attorney shall remain in effect from ________________________ to ________________________.
Signature:
By signing below, I acknowledge that I understand the authority granted under this Power of Attorney.
Parent/Guardian Signature: ________________________
Date: ___________________________
Notarization:
State of New York, County of ______________________
Before me, the undersigned, a Notary Public in and for said State, personally appeared ________________________ and known to me to be the person described in this Power of Attorney, who acknowledged that they executed the same.
Given under my hand this ____ day of ____________, 20__.
Notary Public Signature: ________________________