This Tennessee Power of Attorney for a CHILD is created in accordance with the Tennessee Uniform Power of Attorney Act and allows a parent or guardian to grant certain powers regarding the care and decision-making for their child to another person. This document does not remove the parental or guardianship rights of the parent or guardian.
1. Principal Information (Parent or Guardian)
- Full Name: ___________________________
- Relationship to Child: ___________________________
- Primary Address: ___________________________
- Contact Number: ___________________________
2. Attorney-in-Fact Information (Individual receiving Power of Attorney)
- Full Name: ___________________________
- Relationship to Child: ___________________________
- Primary Address: ___________________________
- Contact Number: ___________________________
3. Child Information
- Full Name: ___________________________
- Date of Birth: ___________________________
4. Term
The powers granted by this document will begin on ______________ and will end on ______________ unless revoked sooner by the undersigned or by law.
5. Powers Granted
This Power of Attorney grants the attorney-in-fact the ability to make decisions regarding the child's:
- Education, including the authority to enroll the child in school and to make decisions regarding the child's participation in extracurricular activities.
- Medical care, including the authority to make healthcare decisions for the child, except the authority to consent to marriage or adoption of the child.
- General welfare, including decisions about the child's living arrangements and travel.
6. Signature of Principal (Parent or Guardian)
I, ___________________________, hereby declare that I am the legal parent/guardian of the above-named child and have the legal authority to grant the power of attorney to the named attorney-in-fact. I understand that this power of attorney can be revoked by me at any time.
Date: ___________________________
Signature: ___________________________
7. Signature of Attorney-in-Fact
I, ___________________________, accept the responsibilities as attorney-in-fact as described in this document, and I agree to act in the child’s best interest to the best of my abilities.
Date: ___________________________
Signature: ___________________________
8. Witness Acknowledgment
This document was signed in the presence of:
- Witness 1 Name: ___________________________
- Witness 1 Signature: ___________________________
- Witness 1 Address: ___________________________
- Date: ___________________________
- Witness 2 Name: ___________________________
- Witness 2 Signature: ___________________________
- Witness 2 Address: ___________________________
- Date: ___________________________