Pennsylvania Power of Attorney for a Child
This Power of Attorney form is executed under the laws of the Commonwealth of Pennsylvania. It allows one person to make decisions on behalf of a child when the parent or legal guardian is unavailable. It is essential to fill out this document carefully to ensure that your wishes are clearly expressed.
Principal Information:
- Full Name: ____________________________________
- Address: ____________________________________
- City, State, Zip Code: _______________________
- Phone Number: _______________________________
Agent Information:
- Full Name: ____________________________________
- Address: ____________________________________
- City, State, Zip Code: _______________________
- Phone Number: _______________________________
Child Information:
- Child's Full Name: ___________________________
- Child's Date of Birth: ______________________
By signing this document, I appoint the above-named Agent to act on my behalf regarding the following matters:
- Health care decisions.
- Education matters.
- Travel arrangements.
- General welfare and day-to-day needs.
This Power of Attorney shall be valid until revoked in writing by the Principal or until the child reaches the age of 18.
Signature of Principal: ________________________
Date: ________________________________________
Witness Signature: ____________________________
Date: ________________________________________
Notary Public:
____________________
____________________
This document should be kept in a safe place. Consider sharing copies with the Agent and any relevant parties to ensure the child's needs are met in case of an emergency.