Wisconsin Minor Child Power Of Attorney

Information you will need

• Child Name
• Child DOB
• Child Address
• Parent Name
• Parent Street Address
• Agent Name
• Agent Address
• Agent Telephone Number
• Agent E mail / Other Contact
• Full Parental Power
• Routine Health Care
• Emergency Blood Transfusion
• Dental Care
• Health Information Disclosure
• Educational / Vocational Services
• Employment
• Confidential Information
• Care and Custody
• Motor Vehicle Operator License
• Out of State Travel
• Substitute Care
• Other Powers / Limited Powers
• Attached Page
• Effective Date

…and 30 more fields in the PDF.

Completed by the agent.

The form includes 1 signature line, a notary acknowledgment.

The document text refers to the laws of Wisconsin.