Arizona Power of Attorney for a Child
This document is a Power of Attorney (POA) for the care and custody of a child, specific to the state of Arizona. It allows a parent, or legal guardian, to grant decision-making rights and responsibilities regarding their child to someone else, referred to as the agent. This document complies with the Arizona Revised Statutes, Section 14-5104.
Principal Information:
Full Name: ____________________________________________
Physical Address: ________________________________________
City, State, ZIP: ________________________________________
Phone Number: __________________________________________
Child Information:
Full Name: ____________________________________________
Date of Birth: _________________________________________
Agent Information:
Full Name: ____________________________________________
Physical Address: ________________________________________
City, State, ZIP: ________________________________________
Phone Number: __________________________________________
Term of POA:
Start Date: _________________________
End Date: ___________________________ (Not to exceed six months, as per Arizona law)
Powers Granted:
This Power of Attorney grants the Agent the authority to act on behalf of the Child in matters concerning:
- Education, including the right to enroll and withdraw the Child in any institution and to authorize participation in school-related activities.
- Medical decisions, including consent to any medical, dental, and mental health treatments.
- Travel authorization, both within and outside of the United States.
- General welfare and care decisions.
Special Instructions:
(if any): ___________________________________________________________________________________________________
____________________________________________________________________________________________________________
Signature Section:
This document must be signed in the presence of a Notary Public, or two adult witnesses who are not related to the Principal, Child, or Agent by blood or marriage.
Principal Signature: ______________________________ Date: ___________
Agent Signature: _________________________________ Date: ___________
Notarization (If applicable):
This section to be completed by a Notary Public:
State of Arizona )
County of __________ )
On this day, ______________, year ____, before me, __________________________________ (Notary’s name), the undersigned Notary Public, personally appeared the above-named Principal and Agent, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.
In Witness Whereof, I hereunto set my hand and official seal.
Notary Public Signature: ___________________________
Seal: