Connecticut Power of Attorney for a Child
This Power of Attorney for a Child document is crafted in accordance with the statutes of the State of Connecticut to grant temporary guardianship and authority over a minor child. By completing this document, the parent(s) or legal guardian(s) nominate a trusted individual to make decisions and act on behalf of the child in their absence. It is a vital tool for ensuring the child's needs are met when the parent(s) or legal guardian(s) are unavailable due to various circumstances such as travel, medical, or military obligations.
Section 1: Child Information
Full Name of Child: ___________________________
Date of Birth: ___________________________
Address: ____________________________________
Section 2: Parent(s)/Legal Guardian(s) Information
Full Name(s) of Parent(s)/Legal Guardian(s): _________________________
Address: _______________________________________________________
Contact Information: ___________________________________________
Section 3: Attorney-in-Fact Information
The person appointed to act on behalf of the child(ren) in the parent(s) or legal guardian(s)' absence is referred to as the Attorney-in-Fact. This individual will have the authority to make decisions regarding the child's education, healthcare, and welfare.
Full Name of Attorney-in-Fact: ______________________________
Address: ____________________________________________________
Contact Information: ________________________________________
Section 4: Powers Granted
The powers granted to the Attorney-in-Fact include, but are not limited to, the following:
- Decision-making related to the child’s education.
- Authority to seek and approve medical treatment for the child.
- Approval of extracurricular activities and travel arrangements.
Section 5: Term
The term of this Power of Attorney begins on the date it is signed and, unless revoked earlier, will terminate on __________________ (insert termination date, not to exceed one year from commencement date, as per Connecticut law).
Section 6: Signature of Parent(s)/Legal Guardian(s)
This Power of Attorney must be signed by the parent(s) or legal guardian(s) in the presence of a notary public or two witnesses, confirming their voluntary grant of power to the Attorney-in-Fact.
Signature: _________________________ Date: ________________________
Print Name: _______________________
Section 7: Acceptance by Attorney-in-Fact
The Attorney-in-Fact must accept this Power of Attorney and agree to undertake the responsibilities it imposes.
Signature: _________________________ Date: _________________________
Print Name: ________________________
Section 8: Witness Declaration
This document must be witnessed by two individuals who can attest to the voluntariness of the parent(s) or legal guardian(s)’ actions. Neither witness should be the appointed Attorney-in-Fact.
Witness 1 Signature: _________________________ Date: ____________________
Print Name: ________________________________
Witness 2 Signature: _________________________ Date: ____________________
Print Name: ________________________________
Note: It is recommended to review this document periodically and after any significant change in circumstance. Consultation with a legal professional is advised to ensure compliance with current Connecticut laws and the document's adequacy in meeting the child's needs.