New Hampshire Power of Attorney for a Child
This Power of Attorney for a Child form is prepared in accordance with New Hampshire laws and is designed to grant certain legal authorities and responsibilities regarding the child to a designated person. Please complete the blanks with accurate and applicable information.
Principal Information:
Name: _____________________________________________________
Address: ___________________________________________________
City, State, Zip: ___________________________________________
Phone Number: _____________________________________________
Child Information:
Name: _____________________________________________________
Date of Birth: _____________________________________________
Attorney-in-Fact Information:
Name: _____________________________________________________
Address: ___________________________________________________
City, State, Zip: ___________________________________________
Phone Number: _____________________________________________
Grant of Power: The Principal hereby appoints the above-named Attorney-in-Fact as their true and lawful attorney to act in the place and stead for the said child concerning the following acts:
- To authorize medical, dental, and mental health treatments.
- To make decisions regarding education, including the school the child will attend.
- To make decisions regarding the child's participation in extracurricular activities, including camps and sports.
- To provide for the child's food, lodging, and travel.
- Other: _________________________________________________
Term: This Power of Attorney shall become effective on ________________ (Date) and shall remain in effect until ________________ (Date), unless sooner revoked by the Principal.
State Specific Acknowledgment: This document is subject to and should be interpreted under the laws of the State of New Hampshire. The Principal acknowledges that this document grants significant powers to the Attorney-in-Fact. It has been executed freely and without any reservation, and it is in the child’s best interest.
Signatures:
Principal Signature: _______________________________ Date: _______________
Attorney-in-Fact Signature: __________________________ Date: _______________
Notary Acknowledgment:
State of New Hampshire)
County of _______________ )
On this, the ____ day of _________, 20___, before me, a notary public, personally appeared ____________________________, known to me (or satisfactorily proven) to be the person whose name is 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: ___________________________
Printed Name: _____________________________________
My commission expires: ____________________________