Illinois Power of Attorney for a Child
This Power of Attorney form is established for the purpose of designating an individual to make medical and educational decisions for a child in accordance with Illinois law.
The undersigned parent(s)/guardian(s), [Parent/Guardian Name], residing at [Address], and [Additional Parent/Guardian Name], residing at [Address], hereby appoints the following individual as the Attorney-in-Fact for our child:
[Agent's Name], residing at [Agent's Address].
This Power of Attorney shall become effective on [Effective Date] and shall remain in effect until [End Date or "revoked by the undersigned"].
The Attorney-in-Fact shall have the authority to:
- Make medical decisions on behalf of the child, including but not limited to consent for treatment, surgery, and other medical care.
- Make educational decisions, including enrolling the child in school, signing report card releases, and decisions related to the child's education.
- Make decisions regarding the child's welfare and any other issues that may arise in the absence of the parent(s)/guardian(s).
The child covered by this Power of Attorney is:
[Child's Name], born on [Child's Date of Birth].
This Power of Attorney is intended to be governed by the laws of the State of Illinois.
In witness whereof, the undersigned has executed this Power of Attorney as of the [Date].
______________________________
[Parent/Guardian Name]
Signature
______________________________
[Additional Parent/Guardian Name]
Signature
______________________________
[Agent's Name]
Signature
Witnessed by:
______________________________
[Witness Name]
Signature
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[Witness Address]