Connecticut Power of Attorney for a Child Form
This Connecticut Power of Attorney for a Child Form is a legal document that allows a parent or guardian to grant decision-making authority and caregiving responsibilities to another trusted adult for a temporary period. As outlined by the Connecticut General Statutes, this form is designed to ensure children have the care and supervision they need when a parent or guardian is unable to provide it due to various reasons such as illness, travel, or military deployment.
Instructions
Complete this form with accurate information where blanks are provided. Consult with a legal professional if you have questions or if your situation involves complex custody, health, or financial issues.
1. Parent/Guardian Information
Full Name of Parent/Guardian Granting Power: ___________________________
Relationship to Child: ___________________________
Primary Address: ___________________________
Contact Number: ___________________________
Email Address: ___________________________
2. Child Information
Full Name of Child: ___________________________
Date of Birth: ___________________________
Primary Address: ___________________________
3. Attorney-in-Fact Information
Full Name of Attorney-in-Fact: ___________________________
Relationship to Child: ___________________________
Primary Address: ___________________________
Contact Number: ___________________________
Email Address: ___________________________
4. Powers Granted
By signing this document, the parent/guardian authorizes the attorney-in-fact to make decisions and act on behalf of the child in matters concerning:
- Health care and medical treatment
- Enrollment and participation in educational activities
- Participation in extracurricular activities
- Travel authorization and arrangements
- Other: _________________________________________
5. Duration
Effective Date: ___________________________
Termination Date: ___________________________ (Not to exceed one year from the effective date without reauthorization)
6. Signatures
This document does not take effect unless the parent/guardian is incapacitated, cannot be contacted, or has voluntarily relinquished care to the attorney-in-fact.
___________________________
Parent/Guardian Signature
___________________________
Date
___________________________
Attorney-in-Fact Signature
___________________________
Date
7. Notarization
This document must be notarized to be valid. Ensure it is signed in the presence of a notary public.
___________________________
Notary Public Signature
___________________________
Date
This is a simplification of a legally binding document. It is recommended to seek legal advice when preparing a power of attorney form.