Virginia Minor Child Power of Attorney Form

The Virginia minor child power of attorney form is a legal document that is completed by parent(s) or a court appointed guardian for use by a temporary custodian for the care of minor child(ren) in the even the parent(s) or guardian will be temporarily absent or should become ill. The document will provide authorization for the temporary custodian to have all the rights needed to properly care and provide for the child(ren) until the parent(s) or guardian resumes custody. The document must be witnessed and signatures must be provided. The document may be revoked at any time.

How to Write

Step 1 – The Parties – Enter:

  • Enter the name(s) of the child(ren)
  • Date of birth in mm/dd/yy format
  • AND
  • Name of Parent or Guardian
  • Select a box to indicate relationship to child(ren)
  • Street address
  • City
  • State
  • AND Co-guardian/parent (if any)
  • Name of Co-parent/guardian
  • Check box indicating relationship to child(ren)

Step 2 – Appointment of Temporary Guardian – Enter the following:

  • Name of temporary custodian
  • Submit the name(s) of the child(ren)
  • Street address
  • City
  • State

Step 3 – Delegation of Powers –

  • Initial and check the box that would indicate the best selection of powers
  • Specific limited powers must be provided if selecting “B”

Step 4 – Commencement and Termination of Document – Provide the following:

  • Date of commencement in dd/mm/yy format
  • Initial and check the box to indicate preferred termination
  • Termination may occur at any time by revocation

Step 5 – Signatures – Must be witnessed:

  • Parent/Court Appointed Guardian Signature
  • Print name
  • Date the signature in mm/dd/yyyy format

Step 6 – Acceptance by Temporary Custodian –

  • Temporary Custodian must review acceptance statement
  • Temporary Custodian’s signature
  • Print name
  • Date the signature in mm/dd/yyyy format

Step 7 – Affirmation by Witnesses –

  • Witnesses must review and agree to the affirmations
  • Enter witnesses names (respectively)
  • Print witnesses names
  • Date witnesses signatures in mm/dd/yyyy format

Step 8 – Notarization –

  • Notary shall witness all signatures
  • Notary shall acknowledge the document by completion of remaining information and by affixing their official seal