Valid Power of Attorney for a Child Template for the State of Connecticut

Connecticut Power of Attorney for a Child

This Power of Attorney is established in accordance with the Connecticut Uniform Power of Attorney Act, allowing a parent or guardian to grant certain powers related to the care and custody of a child to a designated attorney-in-fact.

Please fill in the following information:

Parent/Guardian Information:

• Full Name: ___________________________
• Relationship to Child: ___________________________
• Address: ___________________________
• City: ________________________, State: Connecticut, Zip Code: _________
• Phone Number: ___________________________

Child Information:

• Full Name: ___________________________
• Date of Birth: ________________
• Address: ___________________________
• City: ________________________, State: Connecticut, Zip Code: _________

Attorney-in-Fact Information:

• Full Name: ___________________________
• Relationship to Child: ___________________________
• Address: ___________________________
• City: ________________________, State: Connecticut, Zip Code: _________
• Phone Number: ___________________________

Terms and Conditions:

1. This Power of Attorney shall commence on __________________ (date) and, unless revoked earlier, will terminate on __________________ (date).
2. The attorney-in-fact will have the authority to make decisions concerning the child's education, healthcare, and other activities requiring parental consent.
3. This Power of Attorney does not affect the rights of the child's other parent or legal guardian in matters of the child's care and custody.
4. The parent or guardian retains the right to revoke this Power of Attorney at any time by providing written notice to the attorney-in-fact.

Signature:

Parent/Guardian Signature: ___________________________ Date: ____________

Attorney-in-Fact Signature: ___________________________ Date: ____________

This Power of Attorney for a Child must be notarized to be considered valid under Connecticut law.

Notary Public:

State of Connecticut

County of ______________________

On this, the ______ day of ___________, 20____, before me, _____________________ (name of the notary), a notary public in and for said state, personally appeared ___________________________ (name of the Person giving POA) known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.

In witness whereof, I hereunto set my hand and official seal.

Notary Public Signature: ___________________________ Date: ____________

My Commission Expires: ________________