North Carolina Power of Attorney for a Child
This Power of Attorney is made in accordance with the laws of the State of North Carolina.
Principal: This is the person granting authority.
Name: ________________________________
Address: ____________________________
City, State, Zip: ____________________
Phone: ______________________________
Agent: This is the person receiving authority to act on behalf of the Principal.
Name: ________________________________
Address: ____________________________
City, State, Zip: ____________________
Phone: ______________________________
Child: The minor child for whom authority is being granted.
Name: ________________________________
Date of Birth: ________________________
Address: ____________________________
City, State, Zip: ____________________
Powers Granted: The Agent is granted authority to make decisions regarding:
- Education
- Healthcare
- Emergency care
- Transportation
- General welfare
Limitations: Any limitations on the Agent's authority should be described below:
______________________________________
______________________________________
Effective Date: This Power of Attorney becomes effective on:
Date: ________________________________
Duration: This Power of Attorney shall remain in effect until:
Date: ________________________________
Signatures:
The Principal must sign and date below:
______________________________________
Signature of Principal
Date: ________________________________
The Agent acknowledges and accepts the responsibilities accorded by this Power of Attorney:
______________________________________
Signature of Agent
Date: ________________________________
Witness: This document must be witnessed:
______________________________________
Signature of Witness
Date: ________________________________
______________________________________
Name of Witness (printed)
This Power of Attorney is signed in accordance with North Carolina law.