Oregon Power of Attorney for a Child
This document is intended to grant authority to a designated individual to make decisions on behalf of a child in accordance with Oregon state laws.
Principal Information:
Name of Parent/Guardian: ______________________________________
Address: ______________________________________________________
City, State, Zip Code: _________________________________________
Phone Number: ________________________________________________
Child Information:
Name of Child: _______________________________________________
Date of Birth: ________________________________________________
Agent Information:
Name of Agent: _______________________________________________
Address: ______________________________________________________
City, State, Zip Code: _________________________________________
Phone Number: ________________________________________________
Authority Granted:
The agent is authorized to make decisions regarding the following:
- Medical care and treatment
- Educational decisions
- Travel arrangements
- General welfare of the child
This authority shall commence on the date of signing and will remain in effect until:
- The child reaches the age of majority.
- The parent/guardian revokes this power in writing.
Signatures:
Parent/Guardian Signature: ______________________________________
Date: __________________________________________________________
Agent Signature: _______________________________________________
Date: __________________________________________________________
Notary Public:
State of Oregon
County of _____________________________________________________
Subscribed and sworn before me this ______ day of __________, 20__.
Notary Public Signature: _________________________________________
My Commission Expires: __________________________________________