Tennessee Power of Attorney for a Child
This document serves as a Power of Attorney for a Child in accordance with the laws of Tennessee. This form designates an individual to make medical, educational, and care decisions for the child named herein.
Please fill in the blanks with the appropriate information.
1. Principal Information:
- Child's Full Name: ________________________
- Date of Birth: ________________________
- Address: ________________________
2. Agent Information:
- Agent's Full Name: ________________________
- Relationship to Child: ________________________
- Address: ________________________
- Phone Number: ________________________
3. Duration of Power of Attorney:
Specify the term during which this Power of Attorney will remain in effect:
- Start Date: ________________________
- End Date: ________________________
4. Powers Granted:
The following powers are granted to the Agent for the duration of this Power of Attorney:
- Make medical decisions for the child.
- Authorize medical treatment as necessary.
- Enroll the child in educational programs.
- Make decisions regarding the child’s care and welfare.
The Principal hereby affirms that these powers are necessary for the care of the child and grants them to the Agent as specified above.
5. Signatures:
By signing below, the Principal and Agent acknowledge the terms above:
Signature of Principal: ________________________
Date: ________________________
Signature of Agent: ________________________
Date: ________________________
Witness Signature: ________________________
Date: ________________________
This document must be notarized in accordance with Tennessee law to ensure its validity.