Family & Children

Power of Attorney

Vicky Randolph Vicky Randolph
How To Use

This review list is provided to inform you about this document in question and assist you in its preparation. This is a simple but powerful Power of Attorney for care of your children that has a specific time period. An important feature of this form is the automatic termination date at the end of the period. You can adapt this Power of Attorney to relate to many matters where you want someone to serve as your proxy.

  1. Make sure to limit the time period in the document itself for your own protection. Remember, you can always renew the Power of Attorney, should you want to do so.

  2. A notary is suggested to be sure the Power of Attorney is honored in a crisis. Authorities love the legal niceties; this gives it to them so your agent with the Power of Attorney can act promptly and effectively.

Power of Attorney, Simple

______________________________, the “parent”” of ____________________________, herewith appoints ______________________________ of ___________________________, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to do the following acts:

To act as the guardian of the person of my minor children: ________________________________________________________________________________________

including the right to act entirely in loco parentis; including the authority to approve or to decline medical treatment of any kind for the child and including the right to review medical records or school records of the child.

This power of attorney shall be in effect from ______________________ to ________________________.

As Principal

STATE OF ___________________
COUNTY OF _________________

____________________________ personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.


Notary Public

Commission Expires: ____________________________