North Carolina Minor Child Power of Attorney Form

The North Carolina minor child power of attorney form is a document that provides permission from a parent to a temporary guardian so that, in the event of a medical or dental emergency or the need for preventative or result care, the guardian will have the ability to prove that they may sign for treatment while the child(ren) is/are in the temporary care of the child(ren). This document, however, does not provide permission for a guardian to withhold or withdraw, life sustaining treatments and/or procedures.

This document may only become effective upon Notarization and signatures. The parent may revoke this document immediately at any time, in writing and by service or delivery to the guardian.

How to Write –

Step 1 – Parties – Enter the following:

  • The name of the Parent(s)
  • Provide the family address
  • The County of the family residence
  • AND
  • Enter the name of the child(ren
  • The child(ren’s) name
  • The child(ren”s) dates of birth

Step 2 – Temporary Guardian –

  • Enter the name of the temporary Guardian
  • Enter the address of the Guardian’s residence
  • Both parties must carefully read the remainder of this section

Step 3 – Signature –

  • Parent(s) must read and agree to the paragraph in this section
  • Custodial Parent must provide signature
  • Enter the date of the signature

Step 4 – Notarization –

When the form has been completed and the Notary has witnessed the submission of the Parent’s signature, the notary will complete the acknowledge the document by entering all of the state required information.