Washington Power of Attorney for a Child
This form is designed to allow parents or legal guardians to grant temporary authority to another adult to make decisions and take certain actions regarding the care and welfare of their child(ren) under the laws of the State of Washington, specifically referencing the Washington Uniform Power of Attorney Act (Chapter 11.125 RCW). Please ensure all information is accurate and complete for the form to be valid and effective.
1. Parent/Guardian Information
Name of Parent/Guardian: _______________________________________
Address: ______________________________________________________
City, State, Zip: ______________________________________________
Primary Phone: ____________________ Secondary Phone: _________________
Email Address: _______________________________________________
2. Child Information
Child's Full Name: ____________________________________________
Date of Birth: _______________________________________________
Address: ______________________________________________________
City, State, Zip: ______________________________________________
3. Attorney-in-Fact/Agent Information
Name of Attorney-in-Fact/Agent: _________________________________
Relation to Child: ____________________________________________
Address: ______________________________________________________
City, State, Zip: ______________________________________________
Primary Phone: ____________________ Secondary Phone: _________________
Email Address: _______________________________________________
4. Powers Granted
This Power of Attorney grants the Attorney-in-Fact/Agent authority to act on behalf of the child in matters related to: (Check all that apply)
- Medical decisions and health care
- Education, including school enrollment and activities
- Travel authorization, both domestic and international
- Day-to-day care and supervision
- Access to financial accounts and records related to the child's care
5. Duration
This Power of Attorney shall become effective on ___________________ (date) and shall remain in effect until ___________________ (date), unless terminated earlier by the parent or legal guardian.
6. Signature of Parent/Guardian
I, _______________________________________ (Name of Parent/Guardian), certify that I am the lawful parent or legal guardian of the above-named child and have the legal authority to appoint the above-named Attorney-in-Fact/Agent.
Signature: ______________________________ Date: ________________
7. Signature of Attorney-in-Fact/Agent
I, _______________________________________ (Name of Attorney-in-Fact/Agent), accept the appointment and agree to act to the best of my abilities for the welfare of the child, in accordance with this Power of Attorney and the laws of the State of Washington.
Signature: ______________________________ Date: ________________
8. Notarization (If required by law or preferred by the parent/guardian)
This document was notarized on ____________________ (date) by _____________________________________ (name of notary), a Notary Public in and for the State of Washington.
Notary Signature: __________________________________
Commission Expires: ________________________________
