§ 19-9-134.Power of attorney form

Chapter 9. Child Custody Proceedings · Article 4. Power of Attorney for the Care of a Child · Last amended 2020 · Last verified October 9, 2026

In one sentenceO.C.G.A. § 19-9-134 supplies Georgia’s statutory form for a power of attorney delegating care of a child, says a properly completed form with notarized signatures is legally sufficient, and walks parent and agent through sworn statements on relationship, background checks, powers and duration.

Full Text of § 19-9-134

Text sizeJump to: (a) (b) (c)

(a) The power of attorney contained in this Code section may be used for the temporary delegation of caregiving authority to an agent. The form contained in this Code section shall be sufficient for the purpose of creating a power of attorney under this article, provided that nothing in this Code section shall be construed to require the use of this particular form.

(b) A power of attorney shall be legally sufficient if the form is properly completed and the signatures of the parties are notarized.

Form“FORM FOR POWER OF ATTORNEY TO DELEGATE THE POWER AND AUTHORITY FOR THE CARE OF A CHILD NOTICE: (1) THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE INDIVIDUAL WHOM YOU DESIGNATE (THE AGENT) POWERS TO CARE FOR YOUR CHILD, INCLUDING THE POWER TO: HAVE ACCESS TO EDUCATIONAL RECORDS AND DISCLOSE THE CONTENTS TO OTHERS; ARRANGE FOR AND CONSENT TO MEDICAL, DENTAL, AND MENTAL HEALTH TREATMENT FOR THE CHILD; HAVE ACCESS TO RECORDS RELATED TO SUCH TREATMENT OF THE CHILD AND DISCLOSE THE CONTENTS OF THOSE RECORDS TO OTHERS; PROVIDE FOR THE CHILD'S FOOD, LODGING, RECREATION, AND TRAVEL; AND HAVE ANY ADDITIONAL POWERS AS SPECIFIED BY THE INDIVIDUAL EXECUTING THIS POWER OF ATTORNEY. (2) THE AGENT IS REQUIRED TO EXERCISE DUE CARE TO ACT IN THE CHILD'S BEST INTERESTS AND IN ACCORDANCE WITH THE GRANT OF AUTHORITY SPECIFIED IN THIS FORM. (3) A COURT OF COMPETENT JURISDICTION MAY REVOKE THE POWERS OF THE AGENT. (4) THE AGENT MAY EXERCISE THE POWERS GIVEN IN THIS POWER OF ATTORNEY FOR THE CARE OF A CHILD FOR THE PERIOD SET FORTH IN THIS FORM UNLESS THE INDIVIDUAL EXECUTING THIS POWER OF ATTORNEY REVOKES THIS POWER OF ATTORNEY AND PROVIDES NOTICE OF THE REVOCATION TO THE AGENT OR A COURT OF COMPETENT JURISDICTION TERMINATES THIS POWER OF ATTORNEY. (5) THE AGENT MAY RESIGN AS AGENT AND MUST IMMEDIATELY COMMUNICATE SUCH RESIGNATION TO THE INDIVIDUAL EXECUTING THIS POWER OF ATTORNEY AND TO SCHOOLS, HEALTH CARE PROVIDERS, AND OTHERS KNOWN TO THE AGENT TO HAVE RELIED UPON SUCH POWER OF ATTORNEY. (6) THIS POWER OF ATTORNEY MAY BE REVOKED IN WRITING. IF THIS POWER OF ATTORNEY IS REVOKED, THE REVOKING INDIVIDUAL SHALL NOTIFY THE AGENT, SCHOOLS, HEALTH CARE PROVIDERS, AND OTHERS KNOWN TO THE INDIVIDUAL EXECUTING THIS POWER OF ATTORNEY TO HAVE RELIED UPON SUCH POWER OF ATTORNEY. (7) IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK AN ATTORNEY TO EXPLAIN IT TO YOU. STATE OF GEORGIA COUNTY OF ____________________ Personally appeared before me, the undersigned officer duly authorized to administer oaths, ____________________ (name of parent) who, after having been sworn, deposes and says as follows: 1. I certify that I am the parent of: (Full name of child) (Date of birth) 2. I designate:________________________________________, (Full name of agent) _______________________________________________________, (Street address, city, state, and ZIP Code of agent) _______________________________________________________, (Personal and work telephone numbers of agent) as the agent of the child named above. 3. The agent named above is related or known to me as follows (write in your relationship to the agent; for example, aunt of the child, maternal grandparent of the child, sibling of the child, godparent of the child, associated with a nonprofit or faith based organization): ...................................................................................................................................................................... 4. Sign by the statement you wish to choose (you may only choose one): (A) ___________________________ (Signature) The agent named above is related to me by blood or marriage and I have elected not to have him or her obtain a criminal background check. OR (B) ___________________________ (Signature) The agent named above is not related to me and I have reviewed his or her criminal background check. (If the agent has a criminal conviction, complete the rest of this paragraph.) I know that the agent has a conviction but I want him or her to be the agent because (write in): ................................................................................. 5. Sign by the statement you wish to choose (you may only choose one): (A) ___________________________ (Signature) I delegate to the agent all my power and authority regarding the care and custody of the child named above, including but not limited to the right to inspect and obtain copies of educational records and other records concerning the child, attend school activities and other functions concerning the child, and give or withhold any consent or waiver with respect to school activities, medical and dental treatment, and any other activity, function, or treatment that may concern the child. This delegation shall not include the power or authority to consent to the marriage or adoption of the child, the performance or inducement of an abortion on or for the child, or the termination of parental rights to the child. OR (B) ___________________________ (Signature) I delegate to the agent the following specific powers and responsibilities (write in): ....................................................................................................................................................................................... This delegation shall not include the power or authority to consent to the marriage or adoption of the child, the performance or inducement of an abortion on or for the child, or the termination of parental rights to the child. 6. Initial by the statement you wish to choose (you may only choose one of the three options) and complete the information in the paragraph: (A) ________ (Initials) This power of attorney is effective for a period not to exceed one year, beginning _____________, 2___, and ending _____________, 2___. I reserve the right to revoke this power and authority at any time. OR (B) ________ (Initials) This power of attorney is being given to a grandparent of my child and is effective until I revoke this power of attorney. OR (C) ________ (Initials) I am a parent as described in O.C.G.A. § 19-9-132(b). My deployment is scheduled to begin on _____________, 2____, and is estimated to end on _____________, 2____. I acknowledge that in no event shall this delegation of power and authority last more than one year or the term of my deployment plus 30 days, whichever is longer. I reserve the right to revoke this power and authority at any time. 7. I hereby swear or affirm under penalty of law that I provided the notice required by O.C.G.A. § 19-9-125 and received no objection in the required time period. By:.................................................................................................................................................. (Parent signature) (Printed name) (Street address, city, state, and ZIP Code of parent) (Personal and work telephone numbers of parent) Sworn to and subscribed before me this ________ day of __________, ____. ______________________________ Notary public (SEAL) My commission expires: ___________. STATE OF GEORGIA COUNTY OF ____________________ Personally appeared before me, the undersigned officer duly authorized to administer oaths, ______________________________ (name of agent) who, after having been sworn, deposes and says as follows: 8. I hereby accept my designation as agent for the child specified in this power of attorney and by doing so acknowledge my acceptance of the responsibility for caring for such child for the duration of this power of attorney. Furthermore, I hereby certify that: (A)(i) I am related to the individual giving me this power of attorney by blood or marriage as follows (write in your relationship to the individual designating you as agent; for example, sister, mother, father, etc.): ................................................................. OR (ii) I am not related to the individual giving me this power of attorney but was referred to him or her by: __________________________________________________ (write in the name of the child-placing agency, nonprofit entity, or faith based organization). (B) I am not currently on the state sexual offender registry of this state or the sexual offender registry or child abuse registry for any other state, a United States territory, the District of Columbia, or any American Indian tribe nor have I ever been required to register for any such registry; (C) I have provided a criminal background check to the individual designating me as an agent, if it was required; (D) I understand that I have the authority to act on behalf of the child: •For the period of time set forth in this form; •Until the power of attorney is revoked in writing and notice is provided to me as required by O.C.G.A. § 19-9-130; or •Until the power of attorney is terminated by order of a court; (E) I understand that if I am made aware of the death of the individual who executed the power of attorney, I must notify the surviving parent of the child, if known, as soon as practicable; and (F) I understand that I may resign as agent by notifying the individual who executed the power of attorney in writing by certified mail, return receipt requested, or statutory overnight delivery and I must also notify any schools, health care providers, and others to whom I give a copy of this power of attorney. (Agent signature) (Printed name) Sworn to and subscribed before me this _____ day of ____________________, _____. Notary public (SEAL) My commission expires: _______________. (Organization signature, if applicable) (Printed name and title)”

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Plain-English Summary

This section gives parents a ready-made document. The form may be used for the temporary delegation of caregiving authority, and it’s enough to create a power of attorney under the article. Using this exact form isn’t required, but the document must be in substantially this form. A power of attorney is legally sufficient if the form is properly completed and the parties’ signatures are notarized.

The form opens with a capitalized notice. It tells the parent that the agent will be able to see the child’s school records, arrange and consent to medical, dental and mental health treatment, see those treatment records, provide for the child’s food, lodging, recreation and travel, and use any added powers the parent lists. It warns that the agent must use due care in the child’s best interests, that a court may revoke the agent’s powers, that the agent may resign and must tell the parent and others right away, that the parent may revoke in writing and must notify the agent, schools, health care providers and others who relied on the document, and that the parent should ask a lawyer about anything unclear.

The parent’s part is a sworn statement before an officer authorized to give oaths, with a notary’s signature and seal. The parent names the child and the agent, gives the agent’s contact information and describes their relationship. The parent then signs one of two background-check statements: either the agent is related by blood or marriage and the parent chose not to require a check, or the agent isn’t related and the parent reviewed the check, with an explanation if the agent has a conviction. Next comes a choice between delegating all care and custody authority or listing specific powers; both versions exclude consent to marriage, adoption, abortion and termination of parental rights. The parent initials one of three terms: up to one year with start and end dates, until revoked for a grandparent, or for a deployed parent under § 19-9-132(b) with deployment dates. Finally, the parent swears that he or she gave the notice § 19-9-125 requires and received no objection in time.

The agent then swears, also before a notary, to accept the role and the responsibility of caring for the child, and certifies a family relationship to the parent or a referral from a named child-placing agency, nonprofit entity or faith based organization; that he or she isn’t on, and was never required to register for, a sexual offender or child abuse registry; and that a required background check was provided. The agent also acknowledges how long the authority lasts, the duty to notify a surviving parent if the signer dies, and how to resign. A line for an organization’s signature appears at the end, if one is involved. The section was last amended in 2020.

Frequently Asked Questions

Do I have to use Georgia’s statutory form for a child power of attorney?

Not word for word. The section says nothing in it requires the use of this particular form, but it also says the power of attorney shall be in substantially the form shown. And a power of attorney is legally sufficient if the form is properly completed and the parties’ signatures are notarized.

Who signs the Georgia power of attorney for care of a child form?

The parent and the agent, each under oath before a notary public, who signs and seals each part. The parent signs the delegation and initials the duration choice; the agent signs an acceptance with several certifications. If a child-placing agency, nonprofit entity or faith based organization is involved, the form has a line for its signature too.

What duration options does the Georgia child power of attorney form offer?

Three, and the parent initials one. The first runs for up to one year, with start and end dates the parent fills in. The second is for a grandparent and lasts until the parent revokes it. The third is for a deployed parent under § 19-9-132(b); the parent lists deployment dates and acknowledges the delegation can’t last more than one year or the deployment plus 30 days, whichever is longer.

What powers can I give the agent on the Georgia form?

You sign one of two options. One delegates all your power and authority over the child’s care and custody, including school records, school activities and consent to medical and dental treatment. The other lets you write in specific powers. Either way, the agent can’t consent to the child’s marriage or adoption, to an abortion on or for the child, or to termination of parental rights.

What does the Georgia form say about criminal background checks?

The parent signs one of two statements: that the agent is related by blood or marriage and the parent chose not to require a check, or that the agent isn’t related and the parent reviewed the check, explaining the choice if there’s a conviction. The agent certifies providing a check if one was required. Note that § 19-9-124(e) lists the specific relatives for whom the check may be waived.

Amendment History

Laws 2018, Act 285, § 2-2, eff. Sept. 1, 2018; Laws 2019, Act 321, § 19, eff. May 12, 2019; Laws 2020, Act 410, § 4, eff. July 1, 2020.

Source & verification. Section text and amendment history are reproduced verbatim from the Official Code of Georgia Annotated, enacted by the Georgia General Assembly, and checked word for word against the Georgia Code Revision Commission’s public-domain edition and the acts that later amended it. Section headings are the Code’s official catchlines. Last verified October 9, 2026. · Official source

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