Signing Requirements
A minor child power of attorney must be notarized.[1]
Sample
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We, [PARENT / GUARDIAN NAME] and [PARENT / GUARDIAN NAME], presently residing at [PARENT / GUARDIAN NAME ADDRESS], as the parent(s) and/or custodian(s) of [MINOR CHILD NAME], hereinafter referred to as the child/children, hereby delegate to [AGENT NAME], hereinafter referred to as my/our agent, the authority to act in my/our place and stead with respect to each of the following powers:
- To consent to any necessary medical treatment, surgery, medication, therapy, hospitalization or other such care of or for the child/children;
- To employ, retain or discharge any person who may care for, counsel, treat or in any manner assist the child/children.
- To exercise the same parental rights I/we may exercise with respect to the care, custody and control of the child/children, and the discretion to exercise the same rights in my/our agent’s home or any other place selected by my/our agent in his/her discretion.
- To perform all other acts necessary, or incidental to the execution of the powers enumerated herein;
Any lawful act performed by my/our agent shall be binding upon myself/ourselves, my/our heirs, beneficiaries, personal representatives and assigns. I/We reserve the right to amend or revoke this Limited Power of Attorney at any time hereafter; provided, however, any institution or other party dealing with my agent may rely upon this Limited Power of Attorney until receipt by it of a duly executed copy of my revocation thereof.
Any reproduced copy of this signed original shall be deemed to be an original counterpart of this Limited Power of Attorney. This Limited Power of Attorney shall not be affected by any legal incapacity during my lifetime, except as provided by statute.
This Limited Power of Attorney shall remain in effect from [MM/DD/YYYY] and terminate upon a subsequent written revocation or on [MM/DD/YYYY], whichever shall occur first.
Dated: [MM/DD/YYYY]
Parent/Guardian Signature: _______________________
Print Name: _______________________
Parent/Guardian Signature: _______________________ Date: ______________
Print Name: _______________________
STATE OF __________
COUNTY OF ____________
BE IT REMEMBERED, that on this _____ day of _______, 20__, before me, the subscriber, a Notary Public in and for said County and State, personally came ____________________ and acknowledged the signing of the foregoing instrument, and that the same is his voluntary act and deed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my notarial seal on the day and year first above written.
_______________________________________
Notary Public
My commission expires: ____________