California Power of Attorney for a Child
This Power of Attorney is created in accordance with California law.
Principal: This is the person giving authority.
Name: _________________________________
Address: _______________________________
Phone Number: __________________________
Agent: This is the person taking authority.
Name: _________________________________
Address: _______________________________
Phone Number: __________________________
Child: This is the child for whom the authority is granted.
Name: _________________________________
Date of Birth: __________________________
Powers Granted: The Principal grants the Agent the authority to:
- Make medical decisions for the Child.
- Authorize medical treatment for the Child.
- Sign documents related to the Child's health care.
- Enroll the Child in school or other educational programs.
- Make decisions about the Child's education and extracurricular activities.
Effective Date: This Power of Attorney is effective on:
Date: ________________________________
Termination: This Power of Attorney will terminate on:
Date: ________________________________
Signature:
Principal Signature: ______________________
Date: ________________________________
Witness Signature: ______________________
Date: ________________________________
Notary Public:
State of California
County of _______________________________
Subscribed and sworn to before me on this ______ day of ____________, 20__.
Notary Public Signature: _____________________
My Commission Expires: ________________________