DISTRICT OF COLUMBIA CUSTODIAL POWER OF ATTORNEY
PURSUANT TO D.C. CODE § 21-2301

Please be sure to print and sign the English version. This Custodial Power of Attorney is not required to be notarized, but it is recommended. If you are getting it notarized, do not sign until you are with the notary.

V2.4

1. Parent Information

Parent

2. Child(ren) Information (Max 6)

Child Information

Please indicate the following information about your child(ren)

3. Third Party/Custodian Information

Third Party/Custodian

What is the name of the person you want to grant this power of attorney to?

4. Granted Powers (Click Checkbox to Select)

Select each power you are granting, if you do not wish to grant a specific power, do not select it.

5. Additional Limits on Authority

Optional Limits

If you don't add any additional limitations, the final document will include blank lines for you to write in.

6. Legal Agreement and Limitations

Please read and agree to the following information:

This custodial power of attorney does not include authority to consent to the adoption of the child. In addition, unless otherwise agreed by the parties in writing, the custodial power of attorney granted in this form does not affect:

  • the right of the above-listed child(ren) to inherit from his or her (their) parent;
  • parent's right to visit or contact the child(ren);
  • the parent's right to determine the child(ren)'s religious affiliation;
  • the parent's responsibility to provide financial, medical, and other support for the child(ren).

As set forth in D.C. Code § 21-2301, the custodial power of attorney granted in this form does not affect my rights in any future proceeding concerning custody of the child(ren) or the allocation of parental rights and responsibilities for the child(ren) listed above.

The custodial power of attorney granted in this form shall take effect immediately. It shall continue to be effective even if I become disabled, incapacitated, or incompetent.

The custodial power of attorney granted in this form shall continue until I revoke it in writing and notify the third party listed above in writing of my revocation.

A person or entity that relies on this custodial power of attorney in good faith has no obligation to make any further inquiry or investigation into the authority of the attorney to act as described in this document. Revocation of this custodial power of attorney is not effective as to a person or entity that relies on it in good faith until that person or entity learns of the revocation.

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