Missouri Power of Attorney for a Child
This document allows a parent or legal guardian to designate another adult to make decisions regarding the care and custody of their child. This Power of Attorney is created under Missouri state law.
1. Parent or Guardian Information
Name: ______________________________________
Address: ______________________________________
Phone Number: ________________________________
Email: _______________________________________
2. Attorney-in-Fact Information
Name: ______________________________________
Address: ______________________________________
Phone Number: ________________________________
Email: _______________________________________
3. Child Information
Name: ______________________________________
Date of Birth: ________________________________
Address: ______________________________________
4. Authority Granted
The Attorney-in-Fact shall have the authority to:
- Make decisions regarding the medical care of the child.
- Make decisions regarding the education of the child.
- Make decisions regarding the recreational activities of the child.
- Authorize any necessary emergency medical treatment.
- Engage with schools, health care providers, and other necessary entities on behalf of the child.
5. Duration
This Power of Attorney shall commence on the date signed and shall remain in effect until:
- The child turns 18 years old.
- This Power of Attorney is revoked in writing by the parent or guardian.
- The specified date of termination: __________________.
6. Signature and Acknowledgment
By signing this document, I confirm that I am the parent or legal guardian of the aforementioned child and that I have the legal authority to grant this Power of Attorney.
Parent/Guardian Signature: ____________________________
Date: _______________________________________________
7. Notarization
State of Missouri
County of ______________________
On this _____ day of ____________, 20___, before me, a notary public, personally appeared ____________, known to me to be the person whose name is signed above.
Notary Signature: _________________________________
My Commission Expires: ___________________________