New Jersey Power of Attorney for a Child
This Power of Attorney form is governed by the laws of the State of New Jersey. It allows you to designate an individual to act on behalf of your child.
Parent/Guardian Information:
- Full Name: ______________________________
- Address: ______________________________
- Phone Number: ______________________________
- Email: ______________________________
Child Information:
- Full Name: ______________________________
- Date of Birth: ______________________________
- Address: ______________________________
Agent Information:
- Full Name: ______________________________
- Address: ______________________________
- Phone Number: ______________________________
- Email: ______________________________
Authority Granted:
The agent is granted the authority to make decisions regarding the following:
- Medical care and treatment
- Educational decisions
- Travel arrangements
This Power of Attorney becomes effective on _________(date) and will remain in effect until _________(date) unless revoked in writing.
Signatures:
By signing below, I confirm that I am the parent or legal guardian of the child named above, and I am granting the authority specified in this document.
Parent/Guardian Signature: ______________________________ Date: ______________
Witness Signature: ______________________________ Date: ______________