Tennessee Minor Child Power of Attorney Form

The Tennessee minor child power of attorney form is a legal document that will allow a parent or legal custodian to permit a temporary guardian to properly care for the child(ren) in the event of illness, unexpected emergencies or extended absence for whatever reason.

This document may or may not be sufficient to enroll the child(ren) into a school system or allow them to participate in extracurricular school activities without additional documentation as state by law. To avoid such issues, contact the school district where the child(ren) may be attending to ensure that all of the documentation is provided for the temporary Guardian to avoid the potential delay in structure the child(ren) will require.

This document must be completed and signed before either two witnesses OR a Notary Public. The document may be revoked at any time at the discretion of the parent(s) or legal custodian, by providing written notice to the temporary Guardian.

How to Write

Step 1 – The Parties and Child(ren) – This document must be completed by parent(s) or legal custodian only – Complete the following information:

  • Minor Child(ren’s) Name(s) (if more children must be added, they may be added on a separate sheet with all of the same required information. Be certain to sign and date the document before attachment to this form)
  • Mother or Legal Custodian’s Name and Address
  • Father or Legal Custodian’s Name and Address
  • Temporary Guardian’s (Caregiver’s) Name and Address
  • Check the box that best indicates the situation with regard to the person(s) with current custody of the child(ren)

Step 2 – Hardship Information –

  • The current parent(s) or Legal Custodian must check all boxes that best indicate the reason for the temporary need for a Guardian

Step 3 – Parent(s)/Legal Custodian’s Authorization of Powers for the Child(ren) –

  • Check all boxes that would indicate the powers allowed for the temporary Guardian to utilize with this document
  • If there are other powers to be granted, enter the additional powers in the lines provided on the form

Step 4 – Temporary Guardian (Caregiver)

  • Must carefully read and initial all applicable statement in the section marked “Part II”

Step 5 – Acceptance Statement – (In the Section Marked “Part III”)  –

  • Both the parent(s) and Temporary Guardian must carefully read the entire acceptance paragraph. If all parties agree with the statement, both a parent and the temporary guardian must initial in the spaces preceding the statement

Step 6 – Notarization/Witnesses – All parties who shall sign this document must be sign in the service of a licensed Notary Public OR two (2) witnesses – Make the selection and complete the following per the selection of the parties –

  • Parent(s) or Legal Custodian must first enter the State and County where the document shall be executed
  • Enter the Mother or Legal Custodian’s signature
  • Date the signature in mm/dd/yyyy format
  • The Notary shall complete this section in acknowledgement
  • AND
  • Parent(s) or Legal Custodian must first enter the State and County where the document shall be executed
  • Enter the Father’s or Legal Custodian’s signature
  • Date the signature in mm/dd/yyyy format
  • The Notary Public shall complete this section in acknowledgement
  • AND
  • Parent(s) or Legal Custodian must first enter the State and County where the document shall be executed
  • Enter the Mother or Legal Custodian’s signature
  • Date the signature in mm/dd/yyyy format
  • The Notary shall complete this section in acknowledgement

Witness Attestation to Signature(s) –

  • Should the parties prefer to sign before witnesses, then once the parties have signed before the witnesses, the witnesses must carefully review the Attestation Paragraph
  • If the witnesses are in agreement with the language of the paragraph, each witness must then enter their signatures and date their signatures in mm/dd/yyyy format

The final page of this document should be printed and supplied to the school system for the child(ren’s) records