Illinois Power of Attorney for a Child Template
This document serves as a Power of Attorney specifically for the care and decision-making of a child in the state of Illinois, in accordance with the Illinois Compiled Statutes (ILCS). It is important to ensure that all relevant information is filled out accurately for it to be legally binding.
Principal Information:
- Name: ____________
- Address: ____________
- City, State, Zip Code: ____________
- Email: ____________
- Phone Number: ____________
Agent Information:
- Name: ____________
- Address: ____________
- City, State, Zip Code: ____________
- Email: ____________
- Phone Number: ____________
Child’s Information:
- Name: ____________
- Date of Birth: ____________
- Address: ____________
The Principal hereby appoints the Agent as their lawful attorney-in-fact to make decisions regarding the care and custody of the child.
The powers granted to the Agent include, but are not limited to:
- Making decisions regarding the child’s healthcare.
- Enrolling the child in school and making educational decisions.
- Managing extracurricular activities and providing consent as necessary.
Duration: This Power of Attorney shall remain in effect until ____________ (insert date) or until it is revoked by the Principal.
By signing this document, the Principal affirms that they are of sound mind and are voluntarily granting these powers to the Agent.
Principal’s Signature: _______________________ Date: ____________
Agent’s Signature: _______________________ Date: ____________
Witnesses:
Two witnesses are required to sign below for this document to be valid.
Witness 1 Name: ____________ Signature: _______________________ Date: ____________
Witness 2 Name: ____________ Signature: _______________________ Date: ____________
Notarization:
State of Illinois, County of ____________
Subscribed and sworn before me on this ____________ day of ____________, 20__.
Notary Public Signature: _______________________ My Commission Expires: ____________