New York Power of Attorney for a Child
This Power of Attorney is created in accordance with the laws of the State of New York. This document gives authority to a designated person to act on behalf of the child named herein.
Principal Information:
- Full Name of Parent/Guardian: ____________________________
- Address: ________________________________________________
- Phone Number: _________________________________________
- Email Address: _________________________________________
Agent Information:
- Full Name of Agent: ____________________________________
- Address: ________________________________________________
- Phone Number: _________________________________________
- Email Address: _________________________________________
Child Information:
- Full Name of Child: _____________________________________
- Date of Birth: __________________________________________
Scope of Authority:
The Agent shall have the authority to make decisions regarding:
- Medical treatment and care
- Educational matters
- Extracurricular activities
- Travel arrangements
This Power of Attorney shall be effective from the date of signing and will remain in effect until:
- The date specified: _____________________
- The Principal revokes this Power of Attorney.
Signatures:
By signing below, the Principal grants authority to the Agent to act on behalf of the Child as specified in this document.
Signature of Parent/Guardian: _______________________________
Date: _____________________________________________________
Signature of Agent: _______________________________________
Date: _____________________________________________________