This Utah Power of Attorney for a Child template is designed to temporarily grant certain parental rights and responsibilities from the child's parent(s) or guardian(s) to another individual. In accordance with the Utah Uniform Power of Attorney Act, this document allows the appointed individual to make decisions regarding the child's welfare, including but not limited to education, healthcare, and general caretaking needs.
Please Complete the Information Below:
Child's Full Name: ________________________________
Child's Date of Birth: ____________________________
Parent(s)/Guardian(s) Full Name(s): ________________________________________
Designated Attorney-in-Fact (Individual Granted Power) Full Name: ____________________________________
Relationship to Child: ___________________________________________________
Effective Date of Power of Attorney: _______________________________________
Termination Date of Power of Attorney (if applicable):_________________________
Parental Rights and Responsibilities to be Granted:
- Decision-Making Power Regarding Education
- Decision-Making Power Regarding Healthcare
- General Caretaking Authority
- Authorization to Travel with the Child
- Any Additional Powers: _______________________________________________
This Power of Attorney does not affect the rights of the child's parents or legal guardians to make decisions regarding the child. The parent(s) or guardian(s) retain the right to revoke or terminate this Power of Attorney at any time.
Signatures:
_________________________ _________________________ ___________
Parent/Guardain Signature Printed Name Date
_________________________ _________________________ ___________
Attorney-in-Fact Signature Printed Name Date
State of Utah County of ______________________
This document was acknowledged before me on _______________ (date) by _______________________________ (name(s) of parent(s)/guardian(s)) and _______________________________ (name of attorney-in-fact).
_________________________ _________________________
Notary Public Signature Printed Name
My commission expires: _________________________