Connecticut Minor Child Power of Attorney Form

The Connecticut minor child power of attorney form is a document which would be signed and notarized by a parent providing an Attorney In Fact or Agent, authority to make decisions for the Principal’s minor child(ren). The document is generally used by a parent or parents who will be unavailable for a period of time and wish to grant temporary authority to another person who is willing to provide the best possible care for their child. This document may be used to authorize the person(s) to obtain and/or authorize medical treatment for a child or children, signing for significant decisions with regard to the child(ren). The parent(s) may also limit the allowable duties to specific actions. This document may be revoked at any time by providing revocation in writing to the attorney in fact/agent.

How To Write

Step 1 – Begin by downloading the form. The Parent(s) and the Agent must read information on page one as the actions of both parties will affect the child(ren). At the end of the page, the parent(s) must date the document in a dd/mm/yyyy format.

Step 2 – Appointment of Agent by Parent(s) –

  • In the first line of the document, on page two, enter the name of the parent(s) in printed form
  • In the second line, enter the printed name of the Agent
  • In the third line, enter the name of the child(ren) who will be covered under the document (if additional space is needed to add the names of more than one child, add them on a separate sheet to be attached to this document)

Step 3 – Parent(s) must read paragraphs A through C-

  • In section D, if additional powers will be allowed by the parents, write them into the lines provided. If more room is required, add them onto a separate sheet to be attached to this document
  • In section 3, if the parent(s) would like to exclude powers, they may do so by writing them into the lines provided
  • In section 4, the parent(s) are asked to explain the hardship that is requiring this document for their child(ren). Enter the reason on the lines provided
  • In section 5, (optional) in the event the child requires a guardian by the courts, the parent(s) may nominate a guardian for their child(ren) – Enter the name and physical address of the proposed guardian
  • The parent(s) should read the remaining numbered sections and initial all that apply

Step 4 – Signatures – Prior to provision of any of the required signatures, you must acquire the services of a notary public. Once all parties involved are present before the notary –

  • Enter the first parent’s signature and printed name
  • Enter the second parent’s signature and printed name
  • Enter the selected Agent’s signature and printed name
  • The notary will complete the remainder of the document and affix their state seal
  • The notary will hand the document back to the parent(s)
  • Copies should be made for all records
  • The original shall be provided to the agent for proof of temporary custody
  • This form may be revoked at any time in writing by the parent(s) to the agent and the children may then be released to back into the care and custody of the parent(s)