Adoption Power of Attorney Form

Please fill out the form with your information below.

I. Parties Involved

Grantor

Name

    Address

      Phone number

        Email

          Attorney-in-Fact

          Name

            Address

              Phone number

                Email

                  II. Child Information

                  Name

                    Date of Birth

                      Place of Birth

                        III. Powers Granted

                        The Grantor authorizes the Attorney-in-Fact to act on their behalf concerning the following matters related to the child mentioned above:

                        1. Legal custody and decision-making authority.

                        2. Medical care and treatment decisions.

                        3. Educational enrollment and related matters.

                        4. Any other necessary actions for the child’s welfare and wellbeing.

                        Duration of Power

                        This Power of Attorney shall remain in effect from [Start Date] to [End Date], unless revoked in writing by the Grantor or upon the occurrence of [specify condition, e.g., finalization of adoption].

                        Revocation Clause

                        The Grantor reserves the right to revoke this Power of Attorney at any time by providing written notice to the Attorney-in-Fact.

                        Date:

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