New York Power of Attorney for a Child
This Power of Attorney document is designed for use in the state of New York, in accordance with New York's laws regarding the delegation of parental authority. It allows a parent or guardian to designate another adult to care for their child in particular situations. Please fill in the blanks with the appropriate information.
Principal Information:
- Name of Parent/Guardian: ______________________________
- Address: _____________________________________________
- City, State, ZIP Code: ________________________________
- Phone Number: _______________________________________
Child Information:
- Name of Child: _______________________________________
- Date of Birth: ________________________________________
- Address (if different from Parent/Guardian): ____________________
Attorney-in-Fact (Agent) Information:
- Name of Attorney-in-Fact: _____________________________
- Address: _____________________________________________
- City, State, ZIP Code: ________________________________
- Phone Number: _______________________________________
Authority Granted:
By signing this document, the Principal grants the Attorney-in-Fact authority to make decisions regarding the care, custody, and control of the Child, including but not limited to the following:
- Access to medical treatment and care.
- Enrollment in educational programs.
- Decision-making related to extracurricular activities.
- Travel arrangements and permissions.
Effective Date: This Power of Attorney shall become effective on _______________________ (date) and shall remain in effect until _______________________ (date) or until revoked in writing.
Revocation: This Power of Attorney can be revoked at any time by the Principal by providing written notice to the Attorney-in-Fact. Such notice must include the Principal's signature and date of revocation.
Signature:
By signing below, the Principal confirms that they are the parent or legal guardian of the Child and understands the authority being granted in this document.
_________________________ (Signature of Parent/Guardian)
Date: ______________________
Witnesses:
This document must be signed in the presence of two witnesses or notarized for it to be valid.
_________________________ (Witness #1 Signature)
Name: ______________________ Date: _____________________
_________________________ (Witness #2 Signature)
Name: ______________________ Date: _____________________