Virginia Power of Attorney for a Child
This Power of Attorney for a Child document is designed to grant certain legal rights and responsibilities regarding the care and custody of a minor child, pursuant to the provisions of the Virginia Code. It allows a parent or guardian to assign another person (the agent) the authority to make decisions on behalf of the minor child in their stead. Please fill in the required information where blanks are provided.
Section 1: Child Information
Child's Full Name: _______________________________
Date of Birth: _______________________________
Section 2: Parent/Guardian Information
Full Name: _______________________________
Address: _______________________________
Phone Number: _______________________________
Email Address: _______________________________
Section 3: Agent Information
Full Name: _______________________________
Relationship to Child: _______________________________
Address: _______________________________
Phone Number: _______________________________
Email Address: _______________________________
Section 4: Powers Granted
This Power of Attorney grants the agent the authority to act on behalf of the child in matters relating to:
- Medical care and treatment
- Schooling and educational decisions
- Travel permissions
- Day-to-day care and supervision
- Other: _______________________________
Section 5: Duration
This Power of Attorney shall begin on ________________ and shall remain in effect until ________________, unless otherwise revoked earlier.
Section 6: Signature
This document must be signed by both the parent/guardian and the named agent in the presence of a notary public.
Parent/Guardian Signature: _______________________________
Date: _______________________________
Agent Signature: _______________________________
Date: _______________________________
Notary Public: _______________________________
Date: _______________________________
Section 7: Acknowledgment by Notary Public
This section will be completed by a notary public to acknowledge the signatures of the parent/guardian and agent.