New York Power of Attorney for a Child
This Power of Attorney for a Child document is specifically created in accordance with the laws of the State of New York. It is designed to temporarily grant certain parental or guardian rights to an appointed individual. This document ensures a trusted person can make decisions and provide care for your child in your absence. Please fill in the required information where indicated.
Part 1: Child Information
Child's Full Name: ___________________________________________
Date of Birth: ______________
Address: ____________________________________________________
Part 2: Parent/Guardian Information
Full Name: __________________________________________________
Relationship to Child: ________________________________________
Primary Phone: ______________________
Email: ______________________________________________________
Address (if different from child): _______________________________________________
Part 3: Attorney-in-Fact Information
Full Name of Attorney-in-Fact: ______________________________________________
Relationship to Child: ________________________________________________________
Primary Phone: ___________________________
Email: ____________________________________
Address: ___________________________________________________________________
Part 4: Powers Granted
This Power of Attorney grants the Attorney-in-Fact the authority to act in the parent or guardian’s stead in matters involving the child's:
- Education
- Health care
- Travel arrangements
- Other: _______________________________________________________________
Part 5: Duration
This Power of Attorney shall become effective on __________ [date] and, unless revoked earlier, will remain in effect until __________ [date].
Part 6: Signatures
This document must be signed by the parent or legal guardian, the Attorney-in-Fact, and a Notary Public to be legally binding.
Parent/Guardian Signature: ____________________________________ Date: ____________
Attorney-in-Fact Signature: ____________________________________ Date: ____________
Notarization
This document was acknowledged before me on _______________ [date] by _________________________ [name(s) of person(s)].
Notary Public Signature: ______________________________________
Printed Name: _______________________________________________
Commission Expires: __________________