Virginia Power of Attorney for a Child
This document allows a parent or legal guardian to grant temporary authority to another person to make decisions regarding the care of their child. It complies with Virginia state laws, specifically § 20-166.1 of the Code of Virginia.
Parent/Guardian Information:
- Name: __________________________
- Address: ________________________
- City: ___________________________
- State: __________________________
- Zip Code: ______________________
- Phone Number: __________________
Designated Agent Information:
- Name: __________________________
- Address: ________________________
- City: ___________________________
- State: __________________________
- Zip Code: ______________________
- Phone Number: __________________
Child’s Information:
- Name: __________________________
- Date of Birth: _________________
- Address: ________________________
Powers Granted: The undersigned parent/legal guardian hereby appoints the **Designated Agent** to have the authority to:
- Make decisions regarding the child’s health care and general welfare.
- Enroll the child in school or daycare programs.
- Provide for emergency medical treatment if necessary.
- Make travel arrangements for the child.
Effective Date: This Power of Attorney shall commence on the ____ day of __________, 20___, and shall remain in effect until the ____ day of __________, 20___, unless revoked earlier by the parent/legal guardian.
Signature:
______________________________
Parent/Guardian Signature
Date: ______________________
Witness:
______________________________
Witness Signature
Date: ______________________
Notary Public:
State of Virginia, County of ________________
Subscribed and sworn before me on this ____ day of __________, 20___.
______________________________
Notary Public Signature
My commission expires: ________________