Mississippi Power of Attorney for a Child
This Power of Attorney for a Child document is drafted in accordance with the relevant sections of the Mississippi Code. It is designed to temporarily grant certain parental rights and responsibilities from the parent or legal guardian (hereinafter referred to as the "Grantor") to another individual (hereinafter referred to as the "Attorney-in-Fact").
PLEASE BE AWARE: This document does not provide guardianship of the child. It only allows the Attorney-in-Fact to make certain decisions on behalf of the child for a specified period, not exceeding one year, unless further limited herein or extended by court order.
Grantor's Information:
- Full Name: ___________________________________
- Physical Address: ______________________________
- City, State, Zip: _______________________________
- Phone Number: ________________________________
Child's Information:
- Full Name: ___________________________________
- Date of Birth: ________________________________
- Physical Address: ______________________________
- City, State, Zip: _______________________________
Attorney-in-Fact's Information:
- Full Name: ___________________________________
- Relationship to Child: _________________________
- Physical Address: ______________________________
- City, State, Zip: _______________________________
- Phone Number: ________________________________
Grant of Power:
The Grantor hereby appoints the Attorney-in-Fact as their true and lawful attorney to act in the child's name, place, and stead to make any and all decisions regarding the child's health care, education, and welfare. This includes, but is not limited to:
- Authorization for the child to travel with the Attorney-in-Fact.
- Authority to make educational decisions, including but not limited to enrollment, school choice, and participation in school activities.
- Permission to obtain medical, dental, and mental health treatment and to make health care decisions for the child, including access to the child's medical records.
This Power of Attorney does not authorize the Attorney-in-Fact to consent to marriage or adoption of the child, nor does it give the Attorney-in-Fact the ability to override any existing court orders regarding the child's welfare.
Effective Date and Termination:
This Power of Attorney shall become effective on ______________ [insert start date] and, unless terminated earlier, will expire on ______________ [insert end date, not to exceed one year].
Revocation:
The Grantor may revoke this Power of Attorney at any time by providing written notice to the Attorney-in-Fact.
Acknowledgment by Attorney-in-Fact:
The Attorney-in-Fact acknowledges their acceptance of this appointment and agrees to act in the best interest of the child, to uphold the child's privacy, and to adhere to all applicable laws and regulations.
Signature of Grantor: ____________________________ Date: _________
Signature of Attorney-in-Fact: _____________________ Date: _________
Notarization (if required):
This document was notarized in the State of Mississippi on the _____ day of __________, 20__.
Notary Public: __________________________________
My commission expires: ___________________________
