New Jersey Power of Attorney for a Child
This Power of Attorney for a Child document is drafted in accordance with the laws of the State of New Jersey, allowing a parent or guardian to grant certain powers to a designated agent for caregiving purposes. The rights conferred through this document are temporary and should be used for the care of a minor child when the parent or guardian is unable to do so.
Please fill in the following information accurately:
Parent/Guardian's Full Name: ________________________________
Parent/Guardian's Address: __________________________________
Child's Full Name: __________________________________________
Child's Date of Birth: _______________________________________
Designated Agent's Full Name: _______________________________
Designated Agent's Address: _________________________________
Effective Date of Power of Attorney: _________________________
Termination Date of Power of Attorney: ________________________
The parent or guardian hereby authorizes the designated agent to perform the following acts on behalf of the child:
- Make decisions regarding the child's education, including but not limited to the choice of schools and participation in extracurricular activities.
- Make decisions regarding the child's medical care, including the power to consent to medical and dental treatment.
- Provide for the child's food, lodging, and travel.
- Make decisions concerning the child’s participation in religious activities.
- Access the child’s medical records and communicate with healthcare professionals concerning the child’s health and welfare.
This power of attorney shall not grant the designated agent the power to consent to the marriage or adoption of the child.
Signatures
This document must be signed by the parent or guardian, the designated agent, and notarized to be legally binding.
Parent/Guardian's Signature: ________________________________ Date: _________
Designated Agent's Signature: ________________________________ Date: _________
Notary Public's Signature: ___________________________________ Date: _________
State of New Jersey, County of ___________________________
On this, the ___ day of _________, 20__, before me, a Notary Public in and for said State, personally appeared __________________________, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
Notary Public (Seal): ________________________________________
My Commission Expires: ______________________________________