MINOR (CHILD) POWER OF ATTORNEY FORM

1. THE PARTIES. For the minor child named [MINOR CHILD NAME] born on [MM/DD/YYYY] (hereinafter the “Minor”),

Parent / Guardian: I, [PARENT/GUARDIAN NAME], the parent or court-appointed guardian, with an address of [MAILING ADDRESS],

Parent / Co-Guardian (if applicable): and I, [PARENT/CO-GUARDIAN NAME], the Parent or Court-Appointed Guardian with an address of [MAILING ADDRESS], (hereinafter known as the “Parent(s)/Guardian(s)”),

Attorney-in-Fact: hereby appoint [ATTORNEY-IN-FACT NAME] as the Attorney-in-Fact for the Minor, who is the [RELATION TO CHILD] with an address of [MAILING ADDRESS] (hereinafter the “Attorney-in-Fact”).

2. POWERS. I/We, the Parent(s)/Guardian(s), delegate the Attorney-in-Fact the powers of: (Initial and Check ONE)

[INITIAL] ☐ – All authority I/We have under the State of [STATE].
[INITIAL] ☐ – Only the authority to [DESCRIBE AUTHORITY HERE].

3. COMMENCEMENT. This power of attorney shall commence on [MM/DD/YYYY] and terminate on [MM/DD/YYYY]. Irrespective of the end date, this power of attorney shall terminate in the event of my incapacitation or death.

4. STATE LAW. This power of attorney shall be governed under the laws in the State of [STATE].

5. SIGNATURES.

Parent/Guardian Signature: _______________________ Date: [MM/DD/YYYY]
Print Name: [PARENT/GUARDIAN NAME]

Parent/Guardian Signature: _______________________ Date: [MM/DD/YYYY]
Print Name: [PARENT/GUARDIAN NAME]

6. ACCEPTANCE BY ATTORNEY-IN-FACT.

I, the undersigned Attorney-in-Fact, acknowledge and execute this power of attorney and by such execution do hereby affirm that I accept the appointment and understand the duties under this power of attorney and state law.

Attorney-in-Fact Signature: _______________________ Date: [MM/DD/YYYY]
Print Name: [ATTORNEY-IN-FACT NAME]

7. WITNESS AFFIRMATION.

I witnessed the execution of this power of attorney by the Parent(s)/Guardian(s), and I affirm that the Parent(s)/Guardian(s) appeared to me to be of sound mind, was/were not under duress, and the Parent(s)/Guardian(s) affirmed to me that he/she/they were aware of the nature of this power of attorney and signed it freely and voluntarily.

Witness Signature: _______________________ Date: [MM/DD/YYYY]
Print Name: [WITNESS NAME]
Address: [WITNESS ADDRESS]

Witness Signature: _______________________ Date: [MM/DD/YYYY]
Print Name: [WITNESS NAME]
Address: [WITNESS ADDRESS]

8. NOTARY ACKNOWLEDGMENT.

State of [STATE]
County of [COUNTY]

On [MM/DD/YYYY], before me appeared [PARENT/GUARDIAN NAME(S)] as the Parent(s)/Guardian(s) who proved to me to be the above-named person(s), and in my presence, executed the foregoing instrument and acknowledged that they executed the same as their free act and deed.

_________________________________________
Notary Public

Print Name: [NOTARY NAME]
My Commission Expires: [COMMISSION EXPIRATION]

(Notary Seal)