New York Power of Attorney for a Child
This Power of Attorney form is made in accordance with the laws of the State of New York.
Please fill out the information below:
Principal's Information:
- Name: ______________________________
-
- City, State, Zip: ___________________
- Phone Number: ______________________
Agent's Information:
- Name: ______________________________
- Relationship to Child: ______________
- Address: ____________________________
- City, State, Zip: ___________________
- Phone Number: ______________________
Child's Information:
- Name: ______________________________
- Date of Birth: ______________________
- Address: ____________________________
- City, State, Zip: ___________________
Powers Granted:
The undersigned grants the agent the authority to make decisions regarding:
- Education and school enrollment.
- Medical treatment and health care.
- Travel arrangements.
- Other: ______________________________.
Effective Date: This Power of Attorney becomes effective on: __________________.
Termination: This Power of Attorney shall remain in effect until: __________________.
Principal's Signature: ______________________________________
Date: ______________________________
Agent's Acceptance: I, the undersigned Agent, accept the authority granted to me by this Power of Attorney.
Agent's Signature: ______________________________________
Date: ______________________________