Florida Power of Attorney for a Child
This document allows a parent or legal guardian to grant authority to another individual to make decisions on behalf of their child. This power of attorney is governed by Florida Statutes, Chapter 709.
Instructions: Fill in the blanks with the appropriate information.
Principal Information:
- Full Name of Parent/Guardian: ____________________________
- Address: ____________________________
- City: ____________________________
- State: ____________________________
- Zip Code: ____________________________
- Phone Number: ____________________________
Agent Information:
- Full Name of Agent: ____________________________
- Address: ____________________________
- City: ____________________________
- State: ____________________________
- Zip Code: ____________________________
- Phone Number: ____________________________
Child Information:
- Full Name of Child: ____________________________
- Date of Birth: ____________________________
Scope of Authority: This Power of Attorney grants the Agent the authority to make decisions regarding the following:
- Medical care and treatment of the child
- Education matters
- Travel arrangements
- Other specific decisions: ____________________________
Effective Date: This document shall become effective on the following date: ____________________________.
Expiration: This Power of Attorney will expire on: ____________________________ or upon the revocation by the Principal.
Signature:
By signing below, the Principal confirms that they understand and agree to the terms outlined in this Power of Attorney.
Signature of Parent/Guardian: ____________________________
Date: ____________________________
Witnesses:
Two witnesses must sign below, acknowledging the Principal's signature.
- Witness 1 Signature: ____________________________
- Date: ____________________________
- Witness 2 Signature: ____________________________
- Date: ____________________________
Notary Public:
State of Florida, County of ____________________________
On this ____ day of __________, 20__, before me, a Notary Public, personally appeared ____________________________, who is personally known to me or who has produced ____________________ as identification and who did take an oath.
Notary Public Signature: ____________________________
My Commission Expires: ____________________________