Pennsylvania Minor Child Power of Attorney Form

The Pennsylvania minor child power of attorney form is a legal document that parent(s) or a court appointed guardian would provide for an Agent for the care and temporary custody of their children in the event of illness or an extended absence. The document will provide either full or limited powers, depending upon the needs for the children. The document must be witnessed and may be revoked, in writing, at any time.

Step 1 – The Parties – Enter the following information:

  • Child(ren’s) name(s)
  • Date(s) of birth in dd/m/yy format
  • Name of Parent or Guardian
  • Check the appropriate box
  • Address
  • City
  • State
  • AND

Co-Parent or Co-Guardian information

  • Name
  • Check the appropriate box
  • Address
  • City
  • State

Step 2 – Appointment of Attorney In Fact/Agent – Enter:

  • Name of the Agent
  • Check the applicable box
  • Address
  • City
  • State

Step 3 – Delegated Powers –

  • Check and initial the box that would indicate the powers the parent(s) or Guardian(s) would like to provide
  • If the selection is “B,” enter the specific powers to be delegated

Commencement of document –

  • Enter the date of commencement in dd/m/yy format
  • OR
  • Initial and check the preferred commencement period

Step 4 – Signatures – Submit the following:

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

Step 5 – Acceptance by Agent – The Agent must review and agree to, the acceptance paragraph and enter:

  • Agent’s signature
  • Printed name
  • Date of signature in mm/dd/yyyy format

Step 6 – Affirmations of Witnesses –

  • Each witness must read and agree to their attestation
  • Enter the witnesses signatures
  • Printed names
  • Date the signatures in mm/dd/yyyy format

Notarization –

  • The notary shall witness all signatures
  • The notary will then complete the remainder of the document and affix their seal in acknowledgement