Washington Power of Attorney for a Child
This Power of Attorney is executed in accordance with Washington State laws.
Principal:
Name: ________________________
Address: _____________________
City, State, Zip: ____________
Date of Birth: ________________
Agent:
Name: ________________________
Address: _____________________
City, State, Zip: ____________
Date of Birth: ________________
Child's Information:
Name: ________________________
Address: _____________________
City, State, Zip: ____________
Date of Birth: ________________
Powers Granted:
The Agent shall have the authority to make decisions regarding:
- Healthcare and medical treatment.
- Education and schooling.
- General welfare and living arrangements.
Effective Date:
This Power of Attorney shall become effective on:
Date: ________________________
Duration:
This Power of Attorney will remain in effect until:
Date: ________________________
Signature of Principal:
_____________________________
Date: ________________________
Signature of Agent:
_____________________________
Date: ________________________
This document must be witnessed by two adults and notarized.
Witness 1:
Name: ________________________
Signature: ____________________
Date: ________________________
Witness 2:
Name: ________________________
Signature: ____________________
Date: ________________________
Notary Public:
State of Washington
County of ____________________
On this ____ day of ___________, 20____, before me, a notary public, personally appeared the principal and the witnesses, known to me to be the persons described herein, and acknowledged that they executed the same for the purposes expressed therein.
Notary Signature: ________________
My Commission Expires: ___________