Connecticut Power of Attorney for a Child Template
This document serves as a Power of Attorney for a Child, pursuant to the relevant provisions under Connecticut law, allowing a parent or guardian to grant decision-making authority over their child to another person for a temporary period.
Please complete the following information accurately to ensure the effectiveness of this document:
- Parent/Guardian's Full Name: ___________________________
- Parent/Guardian's Address: ___________________________
- Authorized Agent's Full Name: ___________________________
- Authorized Agent's Address: ___________________________
- Child's Full Name: ___________________________
- Child's Date of Birth: ___________________________
- Effective Date of Power of Attorney: ___________________________
- Termination Date of Power of Attorney: ___________________________
This Power of Attorney shall grant the Authorized Agent the following powers over the specified child:
- To make decisions regarding the child's education, including but not limited to, the authority to enroll the child in school, access school records, and participate in school-related meetings and activities.
- To make decisions regarding the child's medical care, including but not limited to, the authority to consult with healthcare providers, access medical records, and consent to any medical or dental treatment necessary for the child's well-being.
- To make decisions pertaining to the child's participation in extracurricular activities, including but not limited to, enrollment in sports, clubs, and other activities outside of school.
- To make travel arrangements for the child, including but not limited to, consenting to travel within or outside of the state of Connecticut.
This document must be signed and dated by the Parent/Guardian to be considered valid.
Parent/Guardian's Signature: ___________________________
Date: ___________________________
State of Connecticut county of ________________ hereby acknowledges the foregoing signature of the Parent/Guardian on this ____ day of _____________, 20__.
Notary Public Signature: ___________________________
Commission Expires: ___________________________