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Pennsylvania Power of Attorney for Care and Custody of Child

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NOTICE

THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU.

THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT, WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY.

YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.

YOUR AGENT MUST ACT IN ACCORDANCE WITH YOUR REASONABLE EXPECTATIONS TO THE EXTENT ACTUALLY KNOWN BY YOUR AGENT AND, OTHERWISE, IN YOUR BEST INTEREST, ACT IN GOOD FAITH AND ACT ONLY WITHIN THE SCOPE OF AUTHORITY GRANTED BY YOU IN THE POWER OF ATTORNEY.

THE LAW PERMITS YOU, IF YOU CHOOSE, TO GRANT BROAD AUTHORITY TO AN AGENT UNDER POWER OF ATTORNEY, INCLUDING THE ABILITY TO GIVE AWAY ALL OF YOUR PROPERTY WHILE YOU ARE ALIVE OR TO SUBSTANTIALLY CHANGE HOW YOUR PROPERTY IS DISTRIBUTED AT YOUR DEATH. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD SEEK THE ADVICE OF AN ATTORNEY AT LAW TO MAKE SURE YOU UNDERSTAND IT.

A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY.

THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56.

IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.

I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS.

Date:

Principal

Print Name

AGENT'S ACKNOWLEDGMENT

I, have read the attached power of attorney and am the person identified as the agent for the principal. I hereby acknowledge that when I act as agent:

I shall act in accordance with the principal's reasonable expectations to the extent actually known by me and, otherwise, in the principal's best interest, act in good faith and act only within the scope of authority granted to me by the principal in the power of attorney.

Date:

Agent

Print Name

POWER OF ATTORNEY:
CARE AND CUSTODY OF CHILD OR CHILDREN

KNOW ALL MEN BY THESE PRESENTS: That the undersigned, parent(s) of the child(ren) identified below,

residing at hereby make, constitute and

appoint (if more than one attorney-in-fact is appointed, add 'Jointly," "either of them" or "any one of them" to indicate how they must act) as the true and lawful Attorney(s)-in-Fact of the undersigned, to act in name, place and stead of the undersigned, to do and execute all or any of the following acts, deeds and things with respect to the care and custody of the following child(ren):

(a) To participate in decisions regarding the child(ren)'s education including attending conferences with the child(ren)'s teachers or any other educational authorities, granting permission for the child(ren)'s participation in school trips and other activities, and making any other decisions and executing any documents pertinent to their education.

(b) To grant permission and consent to the child(ren) participating in any activity sponsored by any group, association or organization which activity the Attorney(s)-in-Fact may deem appropriate.

(c) To make health care decisions on behalf of the child(ren), including making decisions regarding the child(ren)'s medical or dental care, whether routine or emergency in nature, including admissions to hospitals or other institutions; to consent to, to refuse to consent to, or to withdraw consent to the provision of any care, tests, treatment, surgery, service or procedure to maintain, diagnose or treat a physical or mental condition, as well as the right to sign such medical forms as may be necessary to carry out such decisions; to talk with health care personnel who may be treating the child(ren) and to examine the child(ren)'s medical records and to consent to the disclosure of such records in circumstances the Attorney(s)-in-Fact may deem appropriate; to file claims for medical insurance and to obtain information from any insurance company with respect to any policy of health or medical insurance under which the child(ren) may be insured; provided however, that the Attorney(s)-in-Fact shall not be required to execute any documents which would involve incurring any personal liability for any such treatment and care, and the undersigned affirms that the undersigned will be responsible for payment for any such care or treatment consented to by the Attorney(s)-in-Fact of the undersigned which is not covered by insurance.

(d) To generally do and perform all matters and things, to execute all other instruments of every kind which may be necessary or proper to effectuate all powers hereinabove specifically granted, or any other matter or thing appertaining to the child(ren) of the undersigned, with the same full powers, and to all intents and purposes, with the same validity as the undersigned could, if personally present; and hereby ratifying and confirming whatsoever said Attorney(s)-in-Fact of the undersigned shall and may do, by virtue hereto.

(e) SPECIFICALLY EXCLUDED FROM THE AUTHORITY AND POWERS GRANTED HEREIN IS THE AUTHORITY OR POWER TO CONSENT TO THE MARRIAGE OR ADOPTION OF THE CHILD(REN) NAMED HEREIN.

The powers herein granted to said Attorney(s)-in-Fact of the undersigned shall be exercisable by any one of them or all of them at any time and from time to time from

until

This Power of Attorney shall remain in full force and effect until the date stated above, and any party dealing with the Attorney (s)-in-fact during such time shall be fully protected and is hereby discharged, released and indemnified from so doing in respect of any matter relating hereto unless such particular party shall have received prior notice in writing of the revocation of this Power of Attorney.

We further understand that this temporary power of attorney (delegation) of our parental powers does not relieve us of the primary responsibility of our child.

Signed this day of , 20

Signature

City, County, and State of Residence

ATTESTATION OF WITNESSES

The hereinafter named Witnesses, each declare under penalty of perjury under the laws of the State of Pennsylvania, that the principal is personally known to us, that the principal signed and acknowledged this special power of attorney in our presence, that the principal appears to be of sound mind and under no duress, fraud or undue influence, that we are not the person appointed as attorney-in-fact by this document and that we witnessed this power of attorney in the presence of the principal. We are 18 years of age or older and not the individuals who signed the power of attorney on behalf of and at the direction of the principal, or the notary public, or other person authorized by law to take acknowledgments before whom the power of attorney is acknowledged We are not related to the principal by blood, marriage or adoption, and to the best of our knowledge, are not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law.

Signature

Printed Name

Address

Signature

Printed Name

Address

STATE OF PENNSYLVANIA

County of

On this, the day of , 20, before me

, the undersigned officer, personally appeared

known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained.

In witness whereof, I hereunto set my hand and official seal.

Signature:

Title of Officer:

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What the Pennsylvania Power of Attorney for Care and Custody of Child Is

The Pennsylvania Power of Attorney for Care and Custody of Child is a limited legal authorization that a parent or legal guardian can grant to another adult to provide temporary care, make routine medical and educational decisions, and assume custody responsibilities for a minor child. It is not a termination of parental rights or a formal guardianship; rather, it delegates specific powers and defines their duration and scope. Use of a written, signed form clarifies decision authority for schools, healthcare providers, and caregivers and reduces disputes during short-term absences or emergencies.

Why parents and caregivers use this authorization

A clear Pennsylvania Power of Attorney for Care and Custody of Child documents who can provide care and make decisions when a parent is unavailable, protecting the child and third parties asked to accept delegated authority.

Why parents and caregivers use this authorization

Who typically completes or accepts this document

Parents, legal guardians, family members, and regular caregivers often prepare this form to cover short-term absences, travel, or medical needs.

  • Parents traveling internationally who need a temporary caregiver recognized by airlines and authorities.
  • Grandparents or relatives providing routine childcare and school pick-up authorization during a parent’s absence.
  • Licensed daycares and medical offices verifying consent for non-emergency treatment when a parent cannot be reached.

Primary roles and responsibilities

Parent / Grantor

The parent or legal guardian who completes and signs the form. They specify the scope of care and duration, reserve the right to revoke the authorization, and must ensure third parties understand any limits.

Agent / Caregiver

The adult appointed to act for the child. The agent should be competent to provide day-to-day care, communicate with healthcare and school staff, and follow written limitations or emergency instructions in the document.

Core components to include in a professional form

A well-drafted Pennsylvania Power of Attorney for Care and Custody of Child clearly identifies parties, describes the powers granted, sets effective and expiration dates, and records signature and authentication details to avoid disputes.

Parties

Full legal names and contact details for the parent/guardian (grantor) and the caregiver or agent, including addresses and phone numbers to ensure clear identification.

Child details

Child’s full name, date of birth, and any identifying information such as school, physician, allergies, and medical conditions to help institutions verify authority.

Scope of authority

Specific powers granted such as consenting to routine medical care, enrolling in school, obtaining records, authorizing extracurricular activities, and arranging travel if permitted.

Effective period

Start and end dates or event-based triggers (for example, 'from 06/01/2026 through 06/15/2026' or 'until revoked') to limit the agent’s authority.

Limitations

Any expressly excluded powers such as major medical treatment, non-routine surgery, or decisions affecting parental rights should be clearly described to prevent overreach.

Authentication

Signature lines with dates, and spaces for notarization or witness signatures if required by the receiving institution or state practice.

Step-by-step: completing the Pennsylvania form

Follow these steps in order to prepare a clear, usable document for caregivers and institutions.

  • 01
    Collect IDs: Gather parent, agent, and child identification documents beforehand.
  • 02
    Fill details: Complete party names, child data, powers, and dates accurately.
  • 03
    Add limits: Specify any excluded actions or emergency protocols in writing.
  • 04
    Authenticate: Sign, date, and notarize or witness if required by the recipient.

Configuring an online workflow for the form

Set up a simple electronic workflow so the grantor, agent, and any notary can complete signing and authentication remotely.

Field Configuration
Signer order Parent signs first, then agent, then notary if required
Authentication Use email plus SMS code for reliable signer verification
Audit trail Enable timestamp, IP capture, and event logging for proof
Notary mode Enable remote notary or schedule in-person notarization as needed

Technical considerations for electronic completion

Verify that your chosen e-sign and document platform supports required authentication, audit trails, and any notarization workflow you need.

  • File formats: PDF and DOCX widely accepted
  • Integrations: Works with common systems like Microsoft 365 and Google Workspace
  • Notary support: Remote online notarization support recommended

Typical signing and acceptance process

This sequence describes how a completed form moves from preparation to acceptance by third parties.

  • Prepare document: Complete fields and set effective dates
  • Sign and notarize: Parent signs; obtain notary or witness if needed
  • Provide copies: Share signed copies with agent, school, and medical providers
  • Institution verification: Third parties verify IDs and accept authority as written

Common timing considerations to note

Plan dates and notifications carefully — the effective period, expiration, and any notarization deadlines affect whether institutions will accept the document.

Effective Date:

Start date determines when the agent may act

Expiration Date:

Explicit end date prevents unintended authority continuation

Notarization timing:

Notarize before the agent acts when required

School deadlines:

Provide the signed form before a new school term

Travel windows:

Match travel dates precisely if authorizing travel

Security and compliance details to confirm

Encryption in transit: TLS 1.2/1.3 protection
Encryption at rest: AES-256 data storage
Audit trail: Timestamped events and logs
HIPAA support: BAA available for health data
ESIGN / UETA: Meets electronic signature laws
Certifications: SOC 2 Type II and ISO 27001

Key legal risks and consequences

Rejection by provider: Form refused for insufficient authentication
Unintended authority: Expired or vague dates extend powers
Medical liability: Agent may lack consent for major treatment
Child custody disputes: May complicate later guardianship proceedings
Fraud risk: Poor identification increases misuse chance
Recordkeeping gaps: Lost originals hinder enforcement

Common preparation mistakes to avoid

  • Using informal language that leaves authority ambiguous or overly broad.
  • Failing to include the child’s date of birth and school or physician details for accurate identification.
  • Not notarizing or obtaining witnesses when the receiving party requires them for acceptance.
  • Providing inconsistent or unmatched names versus government-issued identification documents.

Pricing snapshot for common eSignature providers used to deliver this form

Compare typical starting prices and capabilities for eSignature vendors when you need remote signing, notarization, or HIPAA support for a Pennsylvania Power of Attorney for Care and Custody of Child.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Real-world examples of use

Two common scenarios illustrate how a clear authorization helps parents and institutions.

Short family trip

A parent traveling for two weeks prepares the form in advance to authorize a grandparent to enroll the child in summer activities and consent to routine care.

  • The agent uses the document at the pediatric clinic and the community center to confirm authority.
  • The written authorization eliminated repeated phone confirmations, allowed timely care, and was accepted by both school and clinic after notarization.

Temporary deployment

A military parent on short deployment signs a limited authorization allowing a neighbor to manage school permissions and pick up the child.

  • The neighbor presented the notarized form at the school office.
  • The school accepted the notarized document and avoided administrative delays, preserving continuity for the child while the parent was away.

Frequently asked questions and answers

Answers to common questions about validity, notarization, and institutional acceptance for a Pennsylvania Power of Attorney for Care and Custody of Child.


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