Iowa Minor Child Power of Attorney Form

The Iowa minor child power of attorney form is a document that is provided for parent(s) who may need to temporarily place their child(ren) with another person, a temporary guardian(s), in the event of illness or the need to be temporarily absent. The guardian(s), in the parent(s) absence, would be asked to provide safety and to make decisions for their children in all aspects, as if they were present and caring for the child(ren) on their own. The document will grant permission to sign for the child(ren) with regard to medical and dental treatment, school activities, sign for the child(ren) to attend school and any other duties related to proper child care.

This document must be notarized to be effective. The parent(s)may revoke this document at any time, in writing to the guardian(s)

How to Write

Step 1 – Parties – Enter:

  • The name of the minor child(ren)
  • Date(s) of Birth in dd/mm/yyyy format
  • The name of the parent(s)
  • Street Address’
  • City
  • State

If a Co-Parent exists –

  • Enter the name of the other parent
  • Check the appropriate box
  • Street Address
  • City
  • State
  • AND
  • Provide the name of the guardian(s) of the minor child(ren)
  • Enter the relationship of the guardian(s) to the child(ren)
  • Street Address
  • City
  • State

Step 2 – Delegation of Powers – II. I/We delegate to the Attorney-in-Fact the powers of: (Check One)

  • All authority that I have as the minor’s parent/guardian legal under the State of Iowa
  • If checking “Only” enter the powers that are allowed
  • Enter the date of commencement of the document in mm/dd/yyyy format
  • Enter the Ending Date in mm/dd/yyyy format

Step 3 – Parent/Court Appointed Guardian – All signatories must be present before a Notary Public

  • Parent/Court Appointed Guardian Signature
  • Printed name
  • Date of signature(s) in mm/dd/yyyy format

Step 4 – Accept by Guardian(s) –

  • Enter the Guardian’s Signature
  • Printed Name
  • Date of Signature

Affirmation of Witnesses –

  • Each witness must enter their printed name into the paragraph
  • Read the affirmation
  • Enter their signature(s)
  • Printed Names
  • Date the Signature(s)

Once the Notary has collected and recorded Identifications they will enter their information and affix their official seal