Ohio Power of Attorney for a Child
This document constitutes a Power of Attorney for a Child in accordance with the laws of the State of Ohio.
Principal Information:
- Name of Parent/Guardian: ________________________
- Date of Birth: ________________________
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- City, State, Zip Code: ________________________
Agent Information:
- Name of Agent: ________________________
- Date of Birth: ________________________
- Address: ________________________
- City, State, Zip Code: ________________________
Child Information:
- Name of Child: ________________________
- Date of Birth: ________________________
- Address: ________________________
- City, State, Zip Code: ________________________
The undersigned Parent/Guardian grants the Agent full power and authority to act on behalf of the child in the following areas:
- Healthcare Decisions
- Educational Decisions
- Travel Arrangements
- Access to Records
This Power of Attorney shall be effective from the date of signing and will remain in effect until revoked in writing by the Parent/Guardian.
IN WITNESS WHEREOF, the Principal/Guardian has executed this Power of Attorney on this ____ day of ___________, 20__.
Signature of Parent/Guardian: ________________________
Witness Signature: ________________________
Print Name of Witness: ________________________
Notarization:
State of Ohio, County of ______________
Subscribed and sworn to before me this ____ day of __________, 20__.
Signature of Notary Public: ________________________
My Commission Expires: ________________________