Pennsylvania Power of Attorney for a Child
This Power of Attorney for a Child (the "Agreement") is designed to comply with the laws of the Commonwealth of Pennsylvania, allowing a parent or legal guardian (the "Principal") to grant temporary caregiving authority to an appointed individual (the "Agent"). This document grants the Agent authority to make decisions and perform acts related to the care and custody of the Principal's child(ren) as permitted under the Pennsylvania Code.
Principal Information:
Legal Name: ___________________________
Address: _____________________________
City, State, Zip: _________________________
Phone Number: ________________________
Email: _______________________________
Child(ren) Information:
Name(s) and Age(s):
_______________________________________
_______________________________________
Agent Information:
Legal Name: ___________________________
Relationship to Child(ren): ________________
Address: _____________________________
City, State, Zip: _________________________
Phone Number: ________________________
Email: _______________________________
Effective Dates:
Start Date: ___________________________
End Date: ____________________________
This Agreement grants the Agent the authority to act on behalf of the Principal in matters concerning the child(ren)'s education, health care, and other welfare decisions. The specific powers and restrictions are outlined below:
- Authority to enroll the child(ren) in school and access educational records.
- Permission to make health care decisions, including medical, dental, and mental health treatment.
- The ability to arrange for the child(ren)'s travel.
- Any additional powers or restrictions: ___________________________________.
This Agreement does not grant the Agent authority to consent to the marriage or adoption of the child(ren).
Signatures:
This document must be signed by the Principal to be effective. In certain circumstances, it may also be necessary to have the document notarized or witnessed as per Pennsylvania law.
Principal's Signature: ___________________________ Date: ________________
Agent's Signature: _____________________________ Date: ________________
Witness Signature (if required): __________________ Date: ________________
Notarization (if applicable):
A Notary Public must complete this section if notarization is required by Pennsylvania law or requested by the Principal.
State of Pennsylvania )
County of _______________)
On this day, _____________, before me, ________________________ (name of notary), personally appeared ________________________ (name of Principal) and ________________________ (name of Agent), known to me (or satisfactorily proven) to be the individuals whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
Notary Public Signature: _________________________
My Commission Expires: _________________________
This Power of Attorney for a Child shall be governed and construed in accordance with the laws of the Commonwealth of Pennsylvania, regardless of conflicts of law principles.