Child Care Power of Attorney

I, , the parent/legal guardian of , born on , residing at , appoint , residing at , as my true and lawful Attorney-in-Fact.

Granted Powers

This power of attorney enables my Attorney-in-Fact to make decisions and take actions regarding the care, custody, and property of my child listed above, including but not limited to:

Medical and dental care
Enrollment in school or daycare
Travel and transportation
General welfare and support

Effective Start Date:

Effective End Date:

Additional Instructions:

I understand that this power of attorney may be revoked by me at any time in writing.

Parent/Guardian Signature

Date

Attorney-in-Fact Signature

Date