Massachusetts Power of Attorney for a Child
This Power of Attorney for a Child document is designed to grant temporary guardianship powers in accordance with the Massachusetts Uniform Probate Code. It allows a parent or guardian to assign another person (the Attorney-in-fact) the rights to make certain decisions for their child in their absence.
Part 1: Child Information
Full Name of Child: ____________________________
Date of Birth: ____________________________
Primary Address: ____________________________
Part 2: Parent/Guardian Information
Full Name of Parent/Guardian: ____________________________
Primary Address: ____________________________
Contact Number: ____________________________
Part 3: Attorney-in-Fact Information
Full Name of Attorney-in-Fact: ____________________________
Relationship to Child: ____________________________
Primary Address: ____________________________
Contact Number: ____________________________
Part 4: Powers Granted
This Power of Attorney grants the Attorney-in-fact the authority to make decisions in the following areas concerning the child:
- Medical care and treatment
- Education decisions, including the right to enroll the child in school and attend school meetings
- Participation in extracurricular activities
- Travel arrangements and permissions
- Other: ________________________________________
Part 5: Duration
This Power of Attorney shall become effective on __________ (date) and, unless sooner revoked, shall remain in effect until __________ (date), not to exceed a period of six (6) months, as per Massachusetts law.
Part 6: Signatures
I, ________________________ (Parent/Guardian), hereby grant ________________________ (Attorney-in-fact), the power of attorney for my child as described in this document.
Signature of Parent/Guardian: ____________________________
Date: ____________________________
Signature of Attorney-in-Fact: ____________________________
Date: ____________________________
Notarization
This document was acknowledged before me on __________ (date) by ________________________ (name of parent/guardian) and ________________________ (name of Attorney-in-fact).
Signature of Notary Public: ____________________________
My commission expires: ____________________________