North Carolina Power of Attorney for a Child Template
This document serves as a Power of Attorney (POA) specifically for the care and custody of a child, in accordance with the North Carolina General Statutes, Chapter 32A, which pertains to Powers of Attorney.
Part 1: Principal Information
Full Name of Parent(s)/Legal Guardian(s): ___________________________
Address: _________________________________________________________
Contact Number: __________________ Email: _________________________
Part 2: Child Information
Full Name of Child: _______________________________________________
Date of Birth: ___________ Place of Birth: __________________________
Part 3: Attorney-in-Fact Information
Full Name of Attorney-in-Fact: _____________________________________
Relationship to Child: ____________________________________________
Address: _________________________________________________________
Contact Number: __________________ Email: _________________________
Part 4: Powers Granted
The Parent(s)/Legal Guardian(s) hereby grant the following powers to the Attorney-in-Fact:
- Authority to make educational decisions, including but not limited to selecting schools and participating in any school-related meetings or decisions.
- Authority to make medical decisions, including access to medical records, discussing treatments with healthcare providers, and making decisions regarding the child's healthcare.
- Authority to travel with the child, including the ability to make arrangements for passports and other travel documents.
- Any additional powers or restrictions: ____________________________________________________.
Part 5: Term
This Power of Attorney shall commence on _______________ and will terminate on _______________ unless revoked earlier by the Parent(s)/Legal Guardian(s).
Part 6: Signature
This document must be signed by the Parent(s)/Legal Guardian(s), witnessed, and notarized to be valid.
Parent(s)/Legal Guardian(s) Signature: ___________________________ Date: ___________
Attorney-in-Fat Signature: ___________________________ Date: ___________
Witness Signature: ___________________________ Date: ___________
Printed Name: __________________________________________________
Notary Public Signature: ____________________________ Date: ___________
Printed Name: ___________________________________________________
My commission expires: _______________