Illinois Power of Attorney for a Child
This Power of Attorney allows a parent or legal guardian to designate another individual to make decisions on behalf of their child. This form is governed by Illinois law.
Note: This document should be completed with care and may need to be notarized to ensure its validity.
Child's Information:
- Name: ________________________________
- Date of Birth: ________________________
- Social Security Number: ________________
Agent's Information:
- Name: ________________________________
- Address: ______________________________
- Phone Number: _______________________
Parent/Guardian's Information:
- Name: ________________________________
- Address: ______________________________
- Phone Number: _______________________
- Email: ______________________________
Scope of Authority:
The following powers are granted to the Agent:
- To make educational decisions concerning the child.
- To authorize medical treatment for the child.
- To decide on extracurricular and recreational activities.
- To apply for public benefits or programs for the child.
Effective Date:
This Power of Attorney is effective from the date signed until __________ (insert end date) or until revoked in writing.
Signature of Parent/Guardian:
________________________________ (Signature)
Date: _______________________________
Notarization:
State of Illinois
County of ___________________________
Subscribed and sworn before me on this _____ day of __________, 20__.
________________________________ (Notary Public)
My commission expires: ________________