Massachusetts Power of Attorney for a Child
This Power of Attorney for a Child document is specifically tailored for use in the Commonwealth of Massachusetts. It authorizes a designated person, known as the attorney-in-fact, to make certain decisions and perform specific tasks on behalf of the child. It is crafted in accordance with Massachusetts laws to ensure its effectiveness within the state.
Please complete the following information to prepare your Power of Attorney document:
- Full name of the parent(s) or legal guardian(s) granting this power: ___________________________
- Full legal name of the child: ___________________________
- Child's date of birth (MM/DD/YYYY): ___________________________
- Full name of the attorney-in-fact (individual who will be granted authority): ___________________________
- Relationship of the attorney-in-fact to the child: ___________________________
- Effective date of this Power of Attorney (MM/DD/YYYY): ___________________________
- Expiration date of this Power of Attorney, if any (MM/DD/YYYY): ___________________________
- Specific powers granted to the attorney-in-fact (check all that apply):
- _____ Make educational decisions
- _____ Make healthcare decisions, including the power to consent to giving, withholding, or stopping medical treatments, services, or diagnostic procedures for the child
- _____ Choose extracurricular activities
- _____ Make travel arrangements
- _____ Access child's medical records
- _____ Other: ________________________________________
- Full address where the child will reside during this Power of Attorney's effectiveness: ___________________________
- Contact information for parent(s) or legal guardian(s):
- Telephone number: ___________________________
- Email address: ___________________________
- Additional instructions or limitations to the attorney-in-fact's powers, if any: ___________________________
This document must be signed in the presence of a notary public or two (2) witnesses, in accordance with the laws of the Commonwealth of Massachusetts, to ensure its validity.
Signature of Parent/Guardian: ___________________________ Date: ___________________
Signature of Attorney-in-Fact: ___________________________ Date: ___________________
Notary Acknowledgment:
State of Massachusetts
County of ___________________
On this _____ day of ___________, 20XX, before me, a Notary Public in and for said State, personally appeared ___________________________, known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
Notary Public: ___________________________
My Commission Expires: ___________________