Attorney-Verified Power of Attorney for a Child Template for New Hampshire

New Hampshire Power of Attorney for a Child

This Power of Attorney for a Child document is prepared in accordance with the relevant provisions of New Hampshire law, designed to temporarily grant certain parental rights and responsibilities from the parent(s) or legal guardian(s) (the "Principal") to another person (the "Agent").

Principal's Information:

• Full Name: ____________________________
• Physical Address: ____________________________
• City: __________________, State: New Hampshire, Zip: __________
• Contact Number: ____________________________

Child's Information:

• Full Name: ____________________________
• Date of Birth: ____________________________
• Physical Address: Same as Principal ☐, If not, specify: ________________________

Agent's Information:

• Full Name: ____________________________
• Relationship to Child: ____________________________
• Physical Address: ____________________________
• City: __________________, State: __________, Zip: __________
• Contact Number: ____________________________

This document authorizes the Agent to perform acts on behalf of the Principal regarding the care and custody of the above-named child in the Principal’s temporary absence. By executing this document, the Principal does not relinquish their parental rights.

Term:

This Power of Attorney shall become effective on ____/____/____ and, unless sooner revoked by the Principal, will remain in effect until ____/____/____, or for a period not exceeding six (6) months, pursuant to New Hampshire law.

Powers Granted:

These powers include, but are not limited to, the authority to:

1. Access the child’s medical records and make healthcare decisions;
2. Enroll the child in school and make educational decisions;
3. Authorize participation in extracurricular activities;
4. Make travel arrangements for the child;
5. Perform other acts as necessary for the child’s care and welfare.

Special Instructions:

(If applicable, describe any limitations on the Agent's powers or any special instructions here.)

________________________________________________________________

________________________________________________________________

Signature of Principal:

____________________________________ Date: ______/______/______

Signature of Agent:

____________________________________ Date: ______/______/______

Witness Declaration:

We, the undersigned, declare under penalty of perjury under the laws of the State of New Hampshire that the Principal appeared to be of sound mind and free from duress at the time of signing this document, and that they affirmed they understood its purpose, and that we witnessed the Principal's signing or acknowledgement of this form.

Witness 1 Signature: __________________________ Date: ______/______/______

Witness 1 Printed Name: _____________________________

Witness 2 Signature: __________________________ Date: ______/______/______

Witness 2 Printed Name: _____________________________

State of New Hampshire County of __________

This document was acknowledged before me on ____/____/____ by ____________________________ (Principal’s name) and ____________________________ (Agent’s name).

Notary Public Signature: __________________________

My commission expires: ______/______/______