North Carolina Power of Attorney for a Child
This Power of Attorney for a Child document grants authority to an appointed person, known as the Agent, to make decisions and act on behalf of the Child in accordance with the laws of the State of North Carolina.
Be sure to review the specific requirements under North Carolina General Statutes Chapter 32A, Article 1, which may guide the execution of this document.
1. Child Information:
- Child's Full Name: ___________________________
- Date of Birth: ___________________________
- Address: ___________________________
2. Parent/Guardian Information:
- Full Name: ___________________________
- Address: ___________________________
- Primary Phone Number: ___________________________
- Alternate Phone Number: ___________________________
- Email Address: ___________________________
3. Agent Information:
- Full Name: ___________________________
- Relationship to Child: ___________________________
- Address: ___________________________
- Primary Phone Number: ___________________________
- Alternate Phone Number: ___________________________
- Email Address: ___________________________
4. Powers Granted:
This Power of Attorney authorizes the Agent to perform any act, make any decision, or exercise any right or privilege that the Parent/Guardian could perform, decide, or exercise with respect to the Child's health, education, and welfare. This includes but is not limited to the ability to:
- Make medical decisions for the Child;
- Enroll the Child in school and make educational decisions;
- Authorize the Child to participate in extracurricular activities;
- Make travel arrangements for the Child;
- Access the Child's medical, educational, and financial records;
- Make decisions relating to the Child's social life.
5. Effective Date and Duration:
- Effective Date: ___________________________
- Termination Date (if applicable): ___________________________
- This Power of Attorney will remain in effect until the Termination Date, unless revoked earlier.
6. Signatures:
This document must be signed in the presence of a notary public or two adult witnesses, in accordance with North Carolina law. By signing below, the Parent/Guardian acknowledges the transfer of authority to the Agent as described in this document.
Parent/Guardian Signature: ___________________________ Date: ___________________________
Agent Signature: ___________________________ Date: ___________________________
Witness #1 Signature: ___________________________ Date: ___________________________
Witness #2 Signature: ___________________________ Date: ___________________________
Notarization (if applicable):
This document was acknowledged before me on (date) ___________________________ by (name(s) of signer(s)) ___________________________.
Notary Public Signature: ___________________________
My commission expires: ___________________________
