Indiana Power of Attorney for a Child
This document is a Power of Attorney for a Child in accordance with Indiana state laws. It allows a parent or legal guardian to designate another individual to make decisions on behalf of their child.
Parent/Guardian Information:
- Full Name: _________________________
- Address: _________________________
- Phone Number: _________________________
- Email Address: _________________________
Child Information:
- Full Name: _________________________
- Date of Birth: _________________________
- Address: _________________________
Agent Information:
- Full Name: _________________________
- Address: _________________________
- Phone Number: _________________________
- Email Address: _________________________
Scope of Authority:
The Agent shall have the authority to make decisions regarding:
- Education
- Healthcare
- Travel
- General Welfare
Duration: This Power of Attorney shall commence on the following date: _________________________ and shall remain in effect until: _________________________.
Signatures:
By signing below, the Parent/Guardian grants authority to the Agent as stated above.
_________________________ (Parent/Guardian Signature) Date: ____________
_________________________ (Agent Signature) Date: ____________
Notary Acknowledgment:
State of Indiana
County of _________________________
Subscribed and sworn to before me this ______ day of ____________, 20__.
_________________________ (Notary Public Signature) My commission expires: ____________