Rhode Island Minor Child Power of Attorney Form

The Rhode Island Minor Child Power of Attorney Form permits a parent(s) or legal custodian(s) to grant powers to a temporary guardian in case an emergency, illness or extended absence prevents that parent(s) or legal custodian(s) responsibly caring for the minor’s interests and well-being. The parent(s) or legal custodian(s) must provide all of the required information. If there is additional information or instructions that should be applied and there is not enough space on the document, feel free to continue such instructions on a separate sheet of paper, clearly cite reference to it in the form, and attach it prior to signing. Each party listed on this document should sign and date such an attachment as a precautionary measure.

This document must be acknowledged by two witnesses and a licensed Notary Public. This document may be revoked at any time in writing and by service to the Guardian.

How to Write

1 – Download the Document

The Rhode Island Minor (Child) Power of Attorney Form may be found by selecting the link below the image on this page.

2 – Report the Parent(s) and Minor(s)

Item I will require a report on the identities of the Minor(s). Then, you will need to report identity of the  Parent(s)/Guardian(s) assigning the responsibility of the minor’s well being to a third party.

  • Enter the Full Name of the Minor (or Child) on the first blank line in this item.
  • On the second blank space, enter the Calendar Day of the child’s Birth Date
  • On the third and fourth blank spaces, enter the Month then the Year of the child’s Birth Date.
  • Report the Full Name of the individual currently responsible for the minor’s well-being (Parent/Guardian) on the fifth blank space.
  • Indicate if the status of the Parent/Guardian by checking the box labeled “Parent” or the box labeled “Court Appointed Guardian”
  • Next, on the space following the words “…a street address of,” enter the Building Number, Street Name, and Unit Number where the current Parent or Guardian lives.
  • Use the blank spaces following the terms “City of” and “State of” to enter the City and State where the current Parent/Guardian lives

In many cases, there is more than one Parent or Guardian currently in charge of a child’s well being and transferring decision making authority to a third party though this form. Such an individual must be reported below the words “(if co-guardian/parent exists):”

  • On the blank space immediately following the term “And I,” enter the complete Name of the Co-Parent/C0-Guardian who must approve and sign this document
  • Next, mark the box labeled “Parent” or the box labeled “Court Appointed Guardian” to define the entity of the co-Parent/Co-Guardian
  • Finally, utilize the next three blank spaces to report the Building/Street/Unit Number where the Co-Parent/Co-Guardian lives, the City where the Co-Parent/Co-Guardian lives, and the State where the C0-Parent/Co-Guardian lives.

2 – Appointment of Temporary Guardian

After identifying the Parent(s)/Guardian(s), it will be necessary to document the identity of the Temporary Guardian who will receive authoritative powers regarding the minor. Do this by filling in the missing information on the blank spaces in Item II.

  • Submit the name of the Temporary Guardian on the first blank space
  • Enter the relationship of the temporary Guardian to the Child(ren) on the second blank space (i.e. aunt, uncle, grandparent)
  • Enter the street address of the temporary Guardian in the blank space following the words “…street address of”
  • Enter the City and State of residence on the last two blank spaces (in that order).

3 – Delegation of Powers

The wording necessary to grant a Temporary Guardian decision making authority as well as any other responsibilities must be included on this form. To begin, locate Item III then indicate the level of authority the Temporary Guardian should have at his or her disposal. The Parnt(s)/Guardian(s) must choose one of two statements:

  • If the Parent(s)/Guardian(s) wishes to grant all of his/her/their authority to the Temporary Guardian, then Choice A should be initialed by the Parent(s)/(Guardian(s) and the check box marked.
  • If the Parent(s)/Guardian(s) will only give the Temporary Guardian limited authority over the minor’s well-being then, Choice B should be initialed and the check box must be marked. If Choice B is defined, the Parent(s)/Guardian(s) must specifically describe what the Temporary Guardian has the authority to do using the blank lines provided.

4 – Commencement and Termination Dates

The current Parent(s)/Guardian(s) must also define when the Temporary Guardian retains the Power of Attorney and for how long. This should be done in Item IV by supplying the relevant Calendar Dates on the appropriately labeled blank spaces:

  • Use the three blank spaces in the statement beginning with “This power of attorney shall commence…” to report the first Calendar Date the Temporary Guardian is granted his/her status as such

Next define the Termination Date of the Temporary Guardian’s authority by selecting Statement A, B, or C:

  • If the Temporary Guardian’s last day of authority is known, the Parent/Guardian must initial Statement A  and report the last Calendar Date the Temporary Guardian has authority using the three spaces provided
  • If the Temporary Guardian’s last day of authority occurs once the Signature Parent(s)/Guardian(s) become disabled, the Parent(s)/Guardian(s) must initial and check Statement B
  • If the Temporary Guardian’s last day of authority occurs when the Signature Parent(s)/Guardian(s) pass away then Statement C must be initialed and checked

5 -Signatures

Each current Parent(s)/Guardian(s) providing authority to the Temporary Guardian named, the Temporary Guardian, and two Witnesses must provide some information as well as sign this document in the presence of the attending Notary Public. This may be done immediately after Item V:

  • The current Parent/Guardian must sign the blank space following the words “Parent/Court Appointed Guardian Signature”
  • Next, the Signature party must Print his or her Name then enter the Signature Date on the blank spaces below his or her Signature.

Next, the Attorney-in-Fact must read and and acknowledge (by signature) the paragraph under the heading “Acceptance by Attorney-in-Fact:”

  • The Temporary Guardian must sign his o her name on the blank line labeled “Attorney-in-Fact’s Signature”
  • The Temporary Guardian must Print his or her Name on the blank line labeled “Print Name” then enter the Signature Date on the blank line labeled “Date”

The first Witness must locate the heading “Affirmation by Witness 1,” then supply the required items once he or she has read and agreed to the pragraph:

  • The first Witness must print his or her full name on the blank line in this paragraph
  • The first Witness must sign the blank space labeled “Witness 1 Signature”
  • The first Witness must then print his or her Full Name and enter the Signature Date on the spaces following the words “Print Name” and “Date” (respectively).

The second Witness will also need to provide items in the section labeled “Affirmation by Witness 2:”

  • The second Witness must print his or her full Name on the first blank space
  • The second Witness must sign his or her name on the blank line labeled “Witness 2 Signature”
  • The second Witness must print his or her Name and provide the Date of his or her signature in the blank spaces provided below the Signature Line

7 – Notarizing the Signatures

  • Once the Notary has witnessed each signature it will be the Notary’s position to complete the remainder this document in the “Notary Acknowledgment” section with application of all state required information and by affixing the official seal