Indiana Power of Attorney for a Child
This Power of Attorney for a Child is authorized under the state of Indiana law to grant certain powers from the parent(s) or legal guardian(s) of a minor child to a designated attorney-in-fact, allowing them to act in the parent or guardian's place for the care and custody of the minor child in the event the parent or guardian is unable to do so. This document does not terminate parental rights.
1. Principal Information
Name of Parent/Guardian: ___________________________________
Address: ___________________________________
City, State, Zip: ___________________________________
Phone Number: ___________________________________
2. Child Information
Name of Child: ___________________________________
Date of Birth: ___________________________________
Address (if different from above): ___________________________________
3. Attorney-in-Fact Information
Name of Attorney-in-Fact: ___________________________________
Relationship to Child: ___________________________________
Address: ___________________________________
City, State, Zip: ___________________________________
Phone Number: ___________________________________
4. Powers Granted
This document grants the Attorney-in-Fact full authority to act in place of the Parent/Guardian for decisions regarding the health, education, and welfare of the named minor child. This authority includes, but is not limited to:
- Enrollment in school and educational programs
- Medical and dental care decisions
- Authorization for the child to participate in extracurricular activities
- Permission to travel
5. Term
This Power of Attorney is effective upon the date of the last signature below and remains in effect until ___________________________________, unless revoked sooner by the Principal in writing.
6. Signatures
This document must be signed by the Parent/Guardian, the Attorney-in-Fact, and notarized to be valid.
Parent/Guardian Signature: ___________________________________ Date: ___________________________________
Attorney-in-Fact Signature: ___________________________________ Date: ___________________________________
Notary Public: ___________________________________ Date: ___________________________________
State of Indiana, County of ___________________________________
This document was acknowledged before me on (date) ___________________________________ by (name of Parent/Guardian) and (name of Attorney-in-Fact).
Notary Signature: ___________________________________
Seal:
7. Additional Provisions (if any)
____________________________________________________________________________________
____________________________________________________________________________________