Pennsylvania Power of Attorney for a Child
This Power of Attorney document allows you to designate someone to make decisions on behalf of your child in Pennsylvania. This form is in compliance with Pennsylvania laws regarding the delegation of parental authority.
Parent/Guardian Information:
- Full Name: ___________________________
- Address: _____________________________
- City: ___________________________
- State: ___________________________
- Zip Code: ___________________________
- Phone Number: ______________________
Designated Attorney-in-Fact Information:
- Full Name: ___________________________
- Address: _____________________________
- City: ___________________________
- State: ___________________________
- Zip Code: ___________________________
- Phone Number: ______________________
Child’s Information:
- Full Name: ___________________________
- Date of Birth: _______________________
Authority Granted: You can specify the powers you are granting to the attorney-in-fact. This may include but is not limited to:
- Medical decisions
- Educational decisions
- Financial decisions
- Travel consent
Limitations: You may also outline any limitations on the authority granted:
- ____________________________________________________________________
- ____________________________________________________________________
This Power of Attorney is effective from the date signed until ___________ [Date], unless revoked earlier.
Signature:
__________________________ (Parent/Guardian Signature)
Date: ____________
Witness Information:
- Full Name: ___________________________
- Signature: ___________________________
- Date: ____________
By signing this document, you acknowledge that you are granting authority as described above.