California Power of Attorney for a Child
This Power of Attorney form is governed by California state laws regarding delegation of parental authority, as stipulated in the California Family Code Section 4000-4025.
This document allows you to designate another individual to act on your child's behalf in specific matters. Please fill in the blanks with the relevant information.
Principal Information (Parent/Guardian):
- Full Name: ___________________________________
- Address: ___________________________________
- City: ___________________________________
- State: _____________________
- Zip Code: ____________
- Email: ___________________________________
- Phone Number: _____________________________
Agent Information (Designee):
- Full Name: ___________________________________
- Address: ___________________________________
- City: ___________________________________
- State: _____________________
- Zip Code: ____________
- Email: ___________________________________
- Phone Number: _____________________________
Child Information:
- Full Name: ___________________________________
- Date of Birth: ____ / ____ / ________
- Address: ___________________________________
Powers Granted: This Power of Attorney grants the Agent authority to make decisions regarding:
- Medical treatment and healthcare
- Education and school enrollment
- Travel and transportation
- Access to records and information
- Other matters as specified: _________________
Effective Date: This Power of Attorney becomes effective on the following date: ____ / ____ / ________.
Termination: This Power of Attorney will remain in effect until ________________ (specify circumstances, e.g., revocation, a specific date, or until the child reaches a certain age).
Please sign below to validate this document:
Principal's Signature: ___________________________________
Date: ____ / ____ / ________
Witnesses:
1. ___________________________________
2. ___________________________________
Notary Public:
State of California
County of ________________
Subscribed and sworn before me on this ____ day of ____________, 20____.
__________________________
Notary Public Signature