West Virginia Power of Attorney for a Child
This Power of Attorney for a Child document grants temporary authority to an individual to make decisions about a child’s welfare in the state of West Virginia, in compliance with the West Virginia Code, Chapter 49, Article 10. It allows the appointed guardian to make decisions pertaining to the child’s education, health, and other welfare matters.
1. Parties
The Parent(s)/Legal Guardian(s), herein referred to as the "Principal(s)", and the Temporary Guardian, herein known as the "Agent", hereby agree to the following terms:
Principal Information:
Name: _______________________________
Relationship to Child: ___________________
Address: ________________________________
City: __________, State: WV, Zip: ___________
Contact Number: ________________________
Email: _________________________________
Co-Principal Information (if applicable):
Name: _______________________________
Relationship to Child: ___________________
Address: ________________________________
City: __________, State: WV, Zip: ___________
Contact Number: ________________________
Email: _________________________________
Temporary Guardian (Agent) Information:
Name: _______________________________
Address: ________________________________
City: __________, State: WV, Zip: ___________
Contact Number: ________________________
Email: _________________________________
2. Child Information
Child’s Name: _____________________________
Date of Birth (MM/DD/YYYY): ________________
Address: __________________________________
City: __________, State: WV, Zip: ___________
3. Term
This Power of Attorney shall commence on __________ and will remain in effect until __________, unless sooner revoked in writing by the Principal(s).
4. Powers Granted
The Principal(s) grants the following specific powers to the Temporary Guardian (Agent) for the care and welfare of the child:
- Enrollment in school and educational decisions
- Medical, dental, and mental health decisions
- Participation in extracurricular activities
- Authorization for travel
- Other: __________________________________
5. Governing Law
This Power of Attorney shall be governed by the laws of the State of West Virginia without regard to its conflict of law principles..
6. Principal(s) Signature
By signing below, the Principal(s) acknowledges that they have read and understood the terms of this Power of Attorney and voluntarily agree to its terms.
Principal’s Signature: __________________ Date: ___________
Co-Principal’s Signature (if applicable): __________________ Date: ___________
7. Agent's Signature
By signing below, the Agent acknowledges that they have read and understood the terms of this Power of Attorney, agree to its terms, and agree to act in the best interest of the child under the powers herein granted.
Agent’s Signature: __________________ Date: ___________
8. Witness Signatures
This Power of Attorney must be signed in the presence of two witnesses, who have no stake in the agreement.
Witness 1 Signature: __________________ Date: ___________
Witness 2 Signature: __________________ Date: ___________
9. Notarization
This document was acknowledged before me on (date) ___________ by the Principal(s) and Agent named above.
Notary Public’s Signature: __________________
My commission expires: __________________