Tennessee Power of Attorney for a Child
This Power of Attorney document is made in accordance with the Tennessee Uniform Power of Attorney Act, permitting a parent or guardian to grant certain powers regarding the care and custody of a child to another individual.
1. Parties Information
Full Name of Parent/Guardian: ___________________________________________________
Relationship to Child: __________________________________________________________
Full Name of Agent (Individual receiving power of attorney): ___________________________
Relationship to Child: __________________________________________________________
Child's Full Name: _____________________________________________________________
Child's Date of Birth: ___________________________________________________________
2. Term of Agreement
This Power of Attorney shall become effective on _______________________, 20____, and will remain in effect until _______________________, 20____, unless terminated earlier by the undersigned parent or guardian.
3. Powers Granted
The parent/guardian hereby grants the following powers to the designated Agent:
- To consent to medical, dental, and mental health treatment of the child.
- To enroll the child in school and to make decisions regarding the child’s education.
- To make legal decisions on behalf of the child.
- To provide for the child’s food, lodging, housing, recreation, and travel.
4. Additional Provisions
(Any additional powers or limitations on the granted powers can be listed here. If none, write “None.”)
________________________________________________________________________________
________________________________________________________________________________
5. Signatures
This document is signed this ____ day of ____________, 20____.
Parent/Guardian Signature: ______________________________________________________
Date: _________________________________________________________________________
Agent Signature: _______________________________________________________________
Date: _________________________________________________________________________
Address and Contact Information of Agent:
________________________________________________________________________________
________________________________________________________________________________
6. Notarization
This document must be signed in the presence of a notary public.
State of Tennessee
County of ___________________________
On this ____ day of _______________, 20____, before me, __________________________________ (name of notary), a notary public in and for said state, personally appeared ________________________________ (name of parent/guardian), known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
______________________________________
Notary Public
My commission expires: __________________