Power Of Attorney Form For Care Of Minor Nj

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NEW   J ERSEY   L IMITED   P OWER   O F   A TTORNEY  
 
FOR   C ARE   O F   M INOR   C HILD(REN)  
 
   
 
KNOW   A LL   M EN   B Y   T HESE   P RESENT:  
 
That   I /We,___________________________________________   ,   a dult   r esident   c itizen(s)   o f  
_____________   C ounty,   S tate   o f   _ _____________,  
 
hereinafter   “ Natural   G uardian(s)”,   r esiding   a t   _ ____________________  
 
(Address),   _ _________________   ( City),   s tate   t he   f ollowing:  
 
1.                                           N atural   G uardian(s)   i s/are   t he   p arent(s)   o f   t he   f ollowing   M inor  
Child(ren):  
 
Name                                                                                                       A ge                                                           D ate   o f   B irth  
 
  _ __________________                           _ _____                                                 _ _____________  
 
___________________                           _ _____                                                 _ _____________  
 
___________________                           _ _____                                                   _ _____________  
 
   
 
Known   a llergies:  
 
Name   o f   C hild                                                                                                                     K nown   A llergies  
 
_____________________                                                     _ __________________  
 
_____________________                                                     _ __________________  
 
_____________________                                                     _ __________________  
 
  2 .                   N atural   G uardian(s)   h ave   m ade,   c onstituted   a nd   a ppointed,   a nd   b y   t hese  
presents   d o   m ake,   c onstitute   a nd   a ppoint,   _ __________________(name),  
__________________________________________________(address-­‐city-­‐state),   a s   o ur/my   t rue   a nd  
lawful   A ttorney-­‐in-­‐Fact,   h ereinafter   “ Attorney-­‐In-­‐Fact”,   t o   a ct   w ith   t he   l imited  
powers,   a s   s pecified   h erein,   i n   r egard   t he   M inor   C hildren   n amed   a bove.   A s   s uch,   t he  
Attorney-­‐in-­‐Fact   s hall   b e   t he   A ttorney-­‐in-­‐Fact   f or   N atural   P arent(s)   a nd   f or   s aid  
Minor   C hild(ren).  
 

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