Description
Give power of attorney to make medical decisions for your child to a temporary guardian with this template; features space for a notary’s signature and seal.
[Your Name]
[Street Address]
[City, ST ZIP Code]
[Phone]
[Date]
To Whom It May Concern:
I am the parent of [Children’s Names] and I do hereby give my permission to and appoint [Guardian Names] as temporary guardian(s) of my minor child(ren) during the time period [click to select start date] through [click to select end date] only to make any and all necessary decisions about my child(ren)’s health care. Said temporary guardian(s) shall have all of the rights to choosing and authorizing medical treatment for my child(ren) during this time period as I have as a parent.
Sincerely,
STATE OF [State]
COUNTY OF[County]
COUNTY OF
In_____________, on the ____ day of _____________, 20___, before me, a Notary Public in and for the above state and county, personally appeared ___________________, known to me or proved to be the person named in and who executed the foregoing instrument, and being first duly sworn, such person acknowledged that he or she executed said instrument for the purposes therein contained as his or her free and voluntary act and deed.
_______________________________
NOTARY PUBLIC
My Commission Expires: ________
NOTARY PUBLIC
My Commission Expires: ________
(SEAL)
