Virginia Power of Attorney for a Child
This Power of Attorney is made in accordance with the laws of the Commonwealth of Virginia.
This document grants authority to the designated agent to make decisions on behalf of the child named below.
Child's Information:
- Name: _______________________________
- Date of Birth: ________________________
Parent/Guardian Information:
- Name: _______________________________
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- Phone Number: ________________________
Agent Information:
- Name: _______________________________
- Address: _____________________________
- Phone Number: ________________________
Authority Granted:
The agent shall have the authority to make decisions regarding:
- Education
- Health care
- Extracurricular activities
- Travel arrangements
This Power of Attorney shall remain in effect until:
- The child reaches the age of majority (18 years old).
- The parent/guardian revokes this Power of Attorney in writing.
Signatures:
By signing below, the parent/guardian grants the authority described above.
Parent/Guardian Signature: ______________________ Date: ___________
Agent Signature: _______________________________ Date: ___________
Witness Signature: _____________________________ Date: ___________
Witness Name: _________________________________