Kansas Power of Attorney for a Child
This document serves as a Power of Attorney for a Child in the state of Kansas. It allows a parent or legal guardian to designate another individual to make decisions on behalf of their child in specified circumstances. This form is governed by Kansas Statutes Annotated, Chapter 58, Article 6.
Principal Information:
- Parent/Guardian Name: ______________________________
- Address: _________________________________________
- City, State, Zip: ________________________________
- Phone Number: ___________________________________
Agent Information:
- Agent Name: ______________________________________
- Address: _________________________________________
- City, State, Zip: ________________________________
- Phone Number: ___________________________________
Child Information:
- Child's Name: ____________________________________
- Date of Birth: ___________________________________
Authority Granted: The undersigned grants the Agent the authority to make decisions regarding:
- Medical care and treatment.
- Educational decisions.
- Travel arrangements.
- Other specific matters: ____________________________.
Effective Date: This Power of Attorney shall become effective on the date signed and shall remain in effect until revoked in writing.
Signatures:
- Parent/Guardian Signature: ________________________
- Date: _________________________________________
- Witness Signature: _____________________________
- Date: _________________________________________
Notary Public:
State of Kansas, County of ____________________________
Subscribed and sworn to before me this _____ day of ____________, 20__.
Notary Public Signature: ___________________________
My Commission Expires: ____________________________