Indiana Power of Attorney for a Child
This document allows a parent or legal guardian to grant authority to another adult to make decisions on behalf of their child in Indiana, as permitted under state laws.
Principal Information
Parent/Guardian Name: _______________________________________________
Parent/Guardian Address: ____________________________________________
Phone Number: _________________________________________________
Email Address: _________________________________________________
Child Information
Child's Name: _________________________________________________
Child's Date of Birth: __________________________________________
Attorney-in-Fact Information
Attorney-in-Fact Name: __________________________________________
Attorney-in-Fact Address: ________________________________________
Phone Number: _________________________________________________
Email Address: _________________________________________________
Authority Granted
The undersigned parent/guardian hereby grants the Attorney-in-Fact the authority to:
- Make medical decisions for the child.
- Consent to necessary medical treatment.
- Enroll the child in school or daycare.
- Provide for the child's educational needs.
- Make travel arrangements for the child.
Effective Date and Duration
This Power of Attorney shall take effect on _________________________ and shall remain in effect until _________________________, unless revoked in writing prior to that date.
Signature
By signing below, I confirm that I am the legal parent/guardian of the child listed above and that I understand the authority being granted.
Signature of Parent/Guardian: ________________________________________
Date: _______________________________________
Notarization (Optional)
This document should be notarized for additional legal protection:
Notary Public: ___________________________________
Date: _______________________________________
My Commission Expires: ________________________________