Pennsylvania Power of Attorney for a Child Template
This document serves as a Power of Attorney for a Child in accordance with Pennsylvania laws. It allows a parent or guardian to designate another individual to make decisions on behalf of a minor child in the event that the parent or guardian is unavailable. This document should be filled out carefully, ensuring that all information is accurate and up to date.
Parent/Guardian Information:
- Full Name of Parent/Guardian: ____________________________
- Address: ______________________________________________
- City, State, Zip Code: _________________________________
- Phone Number: ________________________________________
- Email Address: ________________________________________
Agent Information:
- Full Name of Agent: _________________________________
- Address: __________________________________________
- City, State, Zip Code: _____________________________
- Phone Number: _____________________________________
- Email Address: _____________________________________
Child Information:
- Full Name of Child: _________________________________
- Date of Birth: ______________________________________
The undersigned hereby appoints the individual named above as the agent to act on behalf of the child for the following purposes:
- Make educational decisions, including the choice of school and participation in programs.
- Access medical records and consent to medical treatment.
- Engage in extracurricular activities, including sports and camps.
- Make decisions related to travel and accommodations.
This Power of Attorney is effective upon signing and will remain in effect until ______________ (insert date), unless revoked in writing by the parent/guardian.
This document must be signed in the presence of a notary public for it to be legally binding.
Signature of Parent/Guardian: _______________________ Date: ______________
Notary Public: _______________________________ Date: ______________