Illinois Power of Attorney for a Child
This document allows a parent or legal guardian in Illinois to delegate specific powers regarding their child to another individual. It complies with Illinois law, specifically 755 ILCS 45/1 et seq.
By executing this Power of Attorney, the undersigned parent or legal guardian grants authority to the designated agent regarding the care and well-being of the child named below.
Child's Information:
- Name: ________________________________
- Date of Birth: _________________________
Parent/Guardian Information:
- Name: ________________________________
-
- Phone Number: ____________________________
Agent Information:
- Name: ________________________________
- Address: ____________________________________
- Phone Number: ____________________________
Authority Granted:
The undersigned parent or guardian grants the Agent the power to:
- Make decisions regarding the health and medical treatment of the child.
- Enroll the child in school and make educational decisions.
- Travel with the child.
- Provide for the child’s daily care and supervision.
- Access records and information necessary for the child's care.
This Power of Attorney will become effective on the date below and will remain in effect until revoked in writing by the undersigned parent or guardian.
Effective Date: ______________________
Signature of Parent/Guardian: ______________________________
Date: ______________________________
Witness: ______________________________
Date: ______________________________
Notary Public: ______________________________
State of Illinois
County of ______________________________
Subscribed and sworn before me this _____ day of ____________, 20__.
Notary Public Signature: ______________________________
My Commission Expires: ______________________________