New York Power of Attorney for a Child
This Power of Attorney for a Child (the "Agreement") is made in accordance with the New York General Obligations Law, allowing a parent or guardian to grant certain powers regarding the care and custody of a child to another individual, known as the "Agent."
NOTICE: This legal document grants temporary authority to another person to make decisions concerning your child. Consult an attorney if you have questions about this Agreement.
Please fill in the blanks with the required information:
1. Date: __________
2. Parent/Guardian's Full Name: ___________________________________
3. Parent/Guardian's Address: _____________________________________
4. Child's Full Name: ____________________________________________
5. Child's Date of Birth: ________________________________________
6. Agent's Full Name: ____________________________________________
7. Agent's Address: _____________________________________________
Powers Granted: As the legal guardian/parent, I hereby designate the above-named Agent to act on my behalf in decisions related to the health, education, and welfare of the child named above, including, but not limited to:
- Authorization for medical treatment and access to medical records.
- Decision making regarding educational matters.
- Permission to travel with the child.
- Authority to make day-to-day decisions regarding the child's care and activities.
This power of attorney shall remain in effect from __________ (start date) to __________ (end date), unless sooner revoked in writing.
Signatures:
Parent/Guardian's Signature: ______________________________ Date: _________
Agent's Signature: ______________________________________ Date: _________
State of New York
County of ________________
Sworn to and subscribed before me this ___ day of ____________, 20___.
Notary Public Signature: ___________________________________
My Commission Expires: ___________________________________
Instructions for Use: After completing this template, review the document for accuracy and completeness. Both the Parent/Guardian and the Agent must sign the document in the presence of a Notary Public. Keep the original document in a safe place and provide copies to the Agent and any relevant institutions, such as schools and healthcare providers.
It's advisable to consult with a legal professional to ensure that this document meets all the requirements and adequately protects your rights and the wellbeing of your child.