Wisconsin Minor Child Power of Attorney Form

The Wisconsin minor child power of attorney form is a document, whereas parent(s) may delegate a temporary guardian to care for their child(ren) in the event of emergency, illness or absence. The document will allow a temporary guardian to perform all of the duties and make the same decisions on behalf of the children, as if the parent(s) were present to care for their children. The form must be witness and signed. The document may be revoked at the parent(s) discretion, by placing a notice in writing to the temporary guardian.

How to Write

Step 1 – Child(ren’s) Information – Enter the following:

  • Names of Children
  • Date(s) of Birth in mm/dd/yyyy format
  • Address

Step 2 – Delegation of Powers – Submit:

  • Parent(s) name(s)
  • Read and agree to the statement
  • Enter the name of a Temporary Guardian (Agent)
  • Agent’s address
  • Telephone number
  • E-mail address or additional contacts
  • Agent’s relationship to the child(ren)
  • AND
  • Check the group of stated powers that would best indicate the powers that the parent(s) wish to grant
  • Once selected, check all of the applicable boxes in the section
  • In the lines provided specify additional or limited powers
  • If attachments are available, check the box
  • See the information stating these documented restrictions

Step 3 – Effective Date and Term of the Delegation –

  • Date the execution of the document in dd/mm/ yyyy format
  • Read information regarding revocation of powers

Step 4  – Parent’s signatures – Enter the following:

  • Mother’s signature
  • Date signature in mm/dd/yyyy format
  • Printed name
  • Address
  • Telephone number(s)
  • Email address
  • AND
  • Father’s signature
  • Printed name
  • Address
  • Telephone numbers
  • Email address

Step 5 – Witness’ Signature -Provide witness information as follows:

  • State of witness residence
  • County
  • Date of signature in dd/m/yyyy format
  • Enter the names of the parent(s)
  • Notary signature

Step 6 – Statement of Agent –

  • Name and address of Agent
  • Parent’s names
  • Names of Child(ren)
  • Agent must read the statement
  • Agent’s signature
  • Date of signature in mm/dd/yyyy format

Step 7 – Parental Location During the Term –

  • Enter the parent’s address(es
  • Telephone number
  • Email address
  • OR (by contacting:)
  • Name of contact
  • Address
  • Phone
  • Email address