Vermont Power of Attorney for a Child
This Power of Attorney form is created in accordance with Vermont state laws. It allows a parent or legal guardian to designate another individual to make decisions on behalf of their child in specific situations.
Principal Information:
- Full Name of Parent/Guardian: ___________________________
- Address: ______________________________________________
- Phone Number: ________________________________________
- Email Address: ________________________________________
Child Information:
- Full Name of Child: ____________________________________
- Date of Birth: _________________________________________
Agent Information:
- Full Name of Agent: ____________________________________
- Address: ______________________________________________
- Phone Number: ________________________________________
- Email Address: ________________________________________
Effective Date: This Power of Attorney shall become effective on: ________________________.
Authority Granted: The undersigned grants the Agent the authority to make decisions regarding the following:
- Medical care and treatment for the child.
- Educational decisions.
- Travel arrangements.
- Any other specific authority: ___________________________.
Duration: This Power of Attorney will remain in effect until: ________________________, unless revoked earlier by the Principal.
Signature:
By signing below, I affirm that I am the parent or legal guardian of the child named above and that I am granting this Power of Attorney willingly and without coercion.
Signature of Parent/Guardian: ___________________________
Date: _________________________________________________
Notary Acknowledgment:
State of Vermont, County of _______________
On this _____ day of _______________, 20____, before me, a Notary Public, personally appeared ____________________, known to me to be the person who executed the foregoing Power of Attorney.
Notary Public Signature: ________________________________
My Commission Expires: ________________________________