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).