Child Care Power of Attorney

I, (Parent/Legal Guardian Name), residing at (Address), hereby appoint:

Attorney-in-Fact Name:

Relationship to Child(ren):

Attorney-in-Fact Address:

Child(ren) Information

Child 1 Name and Date of Birth:

Child 2 Name and Date of Birth:

Additional Children (if any):

Powers Granted

I grant the Attorney-in-Fact the authority to make decisions and take actions concerning the care, custody, and property of the child(ren) named above, including but not limited to:

Enrollment in school and participation in educational activities
Authorization for medical and dental care and treatment
Travel within and outside the state as required
Other care and custody decisions as necessary

Effective Dates

This power of attorney is effective from (Start Date) to (End Date), unless I revoke it sooner in writing.

Additional Instructions or Limitations

Parent/Guardian Signature:

Date:

Attorney-in-Fact Signature:

Date:

Notary Public (if required):