Kansas Minor Child Power Of Attorney

Information you will need

• What’s the parent's name?
• What’s the child's name?
• What’s the second child's name?
• What’s the child's date of birth?
• What’s the agent's name?
• For which children can the agent make medical decisions?
• For which children can the agent make medical arrangements?
• For which children can the agent handle other school matters?
• NOTARY ONLY: What's the county?
• NOTARY ONLY: What's the parent's name?
• NOTARY ONLY: Who's executing this power of attorney?
• NOTARY ONLY: What are the children's names?
• NOTARY ONLY: What day is it?
• NOTARY ONLY: What year is it?
• NOTARY ONLY: What month is it?
• NOTARY ONLY: On what date does the notary's commission expire?
• NOTARY ONLY: Who's making the acknowledgment?
• What’s the second child's date of birth?
• NOTARY ONLY: Who's signing this power of attorney?
• For which children can the agent handle personal and medical information?
• For which children can the agent make decisions regarding education?

Completed by the agent and the principal.

The form includes 1 signature line, a notary acknowledgment.