Childcare Power of Attorney Form
Childcare Power of Attorney Form
Please fill out this form completely to grant legal authority over childcare decisions to another individual.
Parent/Guardian Information
Name
Address
Phone number
Child Information
Name
Date of Birth
Address (if different from above)
Authorized Caregiver Information
Name
Relationship to Child
Address
Phone number
Powers Granted
I, as the parent/guardian of the child named above, grant the following powers to the above-named caregiver.
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Make healthcare decisions
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Enroll the child in school and extracurricular activities
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Sign legal documents related to the child's welfare
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Effective Date and Duration
Start Date
End Date (if applicable)
-
This Power of Attorney will remain in effect until revoked
Signature and Authorization
By signing this form, I confirm that I am granting the above powers to the named caregiver and understand the legal implications of this document.
Name:
Date:
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