 | Illinois Minor Child Power of Attorney Form |
The Illinois minor child power of attorney form is a document that allows the biological parent(s) of a minor child to allow another person or persons to provide temporary guardianship over their child(ren) until the parent(s) may return the child(ren) back into their care.
This document may be revoked by the parent(s) at any time by providing a revocation in writing to the temporary guardian(s)
How to Write
Step 1 – Children’s Information –
- Enter the name(s) of the child(ren) (if more room is required, add a sheet continuing the information and attach to this document)
- Enter the Parent(s) Name(s)
- Enter the “safe family parent(s)” who will serve as Attorney(s) In Fact/Agent(s)
- The parent(s) must read and agree to the remainder of the paragraph
- Once completed, the parent(s) must provide their initials in agreement
- Enter the name of the Agent(s) in order to provide permission for them to have the ability to sign for medical treatment of any kind during their temporary stay
Step 2 – Titled Sections – Parents must read all of the following Titled Sections as follows:
- Physical Examination
- Routine and Ordinary Medical Care
- Diagnosis and Treatment
- Extraordinary Medical Care
- Medical Card or Private Medical Insurance
- Enter all of the children(s) insurance card numbers
- Parent(s) must sign in agreement to pay all uncovered charges
- Date the signature(s)
- Parent(s) must read and initial the next two paragraphs
Step 3 – Lydia/Safe Families for Children –
- Parent(s) must enter the effective date of the document
- Enter a termination date
- Name of Agent
- Read the following three statements
Step 4 – Signatures – Provide the following Signatures –
- Biological Parent(s)/Legal Guardian(s)
- Date the Document in mm/dd/yyyy format
- AND
- Additional Biological Parent(s)/Legal Guardian(s)
- Date the Document in mm/dd/yyyy format
- AND
- Signature of Witness
- Date of Witness Signature
- Check the box at the end of the document to provide copies to Parent(s) with the original document placed with Lydia
