Louisiana Power of Attorney for a Child
This Power of Attorney for a Child is designed to comply with Louisiana law.
By completing this document, you authorize another individual to make decisions regarding the care of your child. It is important to ensure that all sections are filled out accurately.
Child's Information:
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
Principal's Information (Parent/Guardian):
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
- Phone Number: ________________________
Agent's Information (Person Authorized to Act):
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
- Phone Number: ________________________
Powers Granted:
I hereby grant my Agent the authority to:
- Make decisions regarding the child's education.
- Consent to medical treatment for the child.
- Authorize travel for the child.
- Manage any other affairs pertaining to the child's welfare.
This Power of Attorney is effective upon execution and will remain in effect until:
_______________________________ (date), unless revoked earlier in writing.
Signature of Principal: _____________________________
Date: _____________________________
Notary Public:
State of Louisiana
Parish of _____________________________
Subscribed and sworn before me this _____ day of ___________, 20__.
Notary Signature: _____________________________
Commission Expiration: _____________________________