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Preview - New York Power of Attorney for a Child Form

New York Power of Attorney for a Child

This Power of Attorney template is designed for use in New York. It allows a parent or guardian to appoint another individual to make decisions on behalf of their child under specific circumstances.

Parties Involved:

  • Principal: __________________________ (Parent/Guardian Name)
  • Child: __________________________ (Child's Name)
  • Agent: __________________________ (Agent's Name)

Appointment of Agent:

I, __________________________, the undersigned Parent/Guardian of __________________________, hereby appoint:

Agent's Name: __________________________

Agent's Address: __________________________

Agent's Phone Number: __________________________

This Power of Attorney gives the Agent the authority to:

  1. Make decisions regarding medical care and treatment for the child.
  2. Sign documents related to the child’s education.
  3. Authorize participation in extracurricular activities.
  4. Make decisions regarding the child's welfare and living arrangements.

Duration: This Power of Attorney is effective from _______________ until _______________ (date). It may be revoked before this time if written notification is given to the Agent.

Notarization: This document must be signed in front of a notary public.

Signatures:

Parent/Guardian Signature: __________________________

Date: _______________

Agent Signature: __________________________

Date: _______________

WITNESS:

Signature: __________________________

Date: _______________

Notary Public:

State of New York) ______________________

County of ______________________

On this ____ day of ________________, 20___, before me, the undersigned, a Notary Public in and for said state, personally appeared __________________________ to me known to be the individual described in and who executed the foregoing instrument.

Signature of Notary: __________________________

My Commission Expires: _______________

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  • Medical Power of Attorney: This form specifically designates someone to make medical decisions for another person. Like the Power of Attorney for a Child, it focuses on the well-being of an individual, particularly in healthcare situations.
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