Ohio Power of Attorney for a Child
This Power of Attorney is made in accordance with the Ohio Revised Code § 3109.52, allowing a parent or legal guardian to appoint an agent to make decisions for their child.
Principal Information:
- Parent/Guardian Name: _______________________________
- Address: ____________________________________________
- City, State, ZIP Code: _______________________________
- Phone Number: ______________________________________
Agent Information:
- Agent Name: ________________________________________
- Address: ____________________________________________
- City, State, ZIP Code: _______________________________
- Phone Number: ______________________________________
Child Information:
- Child's Name: ______________________________________
- Child's Date of Birth: _______________________________
- Child's Address (if different from Principal): ___________
Powers Granted:
The Parent/Guardian hereby grants the Agent the authority to:
- Make medical and dental decisions for the child.
- Make educational decisions, including school enrollment and attendance.
- Provide consent for the child to participate in extracurricular activities.
- Authorize travel for the child.
- Make emergency decisions on behalf of the child.
Effective Date:
This Power of Attorney will become effective on this date: ________________.
Duration:
This Power of Attorney will remain in effect until ______________ (insert end date), unless revoked in writing by the Principal.
Signature:
By signing below, the Principal affirms that they understand and agree to the provisions of this Power of Attorney.
______________________________
Signature of Parent/Guardian
Date: ________________________
______________________________
Signature of Agent
Date: ________________________
Notary Public:
This document was acknowledged before me on ___________ by ______________________ (name of the Principal).
_______________________________
Notary Public Signature
My Commission Expires: __________