Michigan Power of Attorney for a Child
This document serves as a Power of Attorney for the purpose of designating an individual to care for your child, in accordance with Michigan laws. By completing and executing this document, you are granting another person the authority to make decisions regarding your child’s well-being, education, and health.
Principal Information:
- Full Name of Parent/Guardian: ___________________________
- Address: ______________________________________________
- Phone Number: ________________________________________
- Email Address: _________________________________________
Agent Information:
- Full Name of Agent: _________________________________
- Address: ___________________________________________
- Phone Number: ______________________________________
- Email Address: ______________________________________
Child Information:
- Full Name of Child: __________________________________
- Date of Birth: ______________________________________
Powers Granted:
Through this Power of Attorney, the Agent is authorized to:
- Make decisions regarding the child’s education.
- Authorize medical treatment and access medical records.
- Make day-to-day decisions about the child’s care.
- Provide consent for participation in extracurricular activities.
Duration of Power of Attorney:
This Power of Attorney shall begin on the date it is signed and shall continue until ____________________ or until revoked in writing by the Principal.
Signatures:
By signing below, I, the Principal, affirm that I am the parent or legal guardian of the child named above. I understand the powers I am granting and the significance of this document.
_________________________
Signature of Principal
_________________________
Date
_________________________
Signature of Agent
_________________________
Date
Notary Public:
This document must be notarized to be effective. Please see a Notary Public to witness the signatures.