Tennessee Minor Child Power of Attorney Form

Tennessee Minor Child Power of Attorney Form Details

The free power of attorney form TN PDF on this page is the Department of Children's Services form CS-0817.^[2] FormsPal's Create My Document builder makes a separate document. If you need a different document, see all Tennessee POA forms or browse the full power of attorney library.

Tennessee Law for a Minor Child Power of Attorney

Section 34-6-302 of the Tenn. Code Ann. lets a parent delegate temporary care-giving authority over a minor child to an adult who lives in Tennessee. The parent does this in writing, without the approval of a court, when hardship prevents the parent from caring for the child.^[1.1]

The power of attorney must be executed in writing using a form provided by the Tennessee Department of Children's Services and does not require court approval.^[1.1] The Department of Children's Services form for this is CS-0817, Power of Attorney for Care of a Minor Child, the PDF on this page. The form says its use is authorized by T.C.A. § 34-6-301 et seq.^[2]

The statute says hardships may include, but are not limited to, these situations:^[1.1]

• The serious illness or incarceration of a parent or legal guardian.
• A physical or mental condition of the parent, the legal guardian or the child that makes it impossible to provide care and supervision for the child.
• The loss or uninhabitability of the child's home because of a natural disaster.

Choosing the Agent

The agent can be any adult person residing in Tennessee.^[1.1] Pick someone you trust and who can take over the child's daily care when you cannot.

Signing Rules for a Tennessee Minor Child Power of Attorney

The parent must sign the power of attorney. That signature must then be acknowledged before a notary public or in front of two witnesses.^[1.2] Either option meets the statute, so a notary and two witnesses are not both required.

The power of attorney for care of the minor child shall be signed by the parent and acknowledged before a notary public or two (2) witnesses who shall sign and date their signatures concurrently and in each other's presence.

In plain words, the witnesses sign and date the document at the same time. Each witness must be present when the other one signs.

How CS-0817 is signed. Page 4 of CS-0817 has three signing blocks, for the Mother/Legal Guardian, the Father/Legal Guardian and the Caregiver. Each block has a signature line and a Date line, then a statement that the signer personally appeared before a notary public, with a NOTARY PUBLIC signature line and a My commission expires line.^[2] Before that, the parents fill out and initial Part I, the caregiver initials Part II, and the parents and the caregiver both initial Part III.^[2] The form has no lines for witnesses.^[2]

What the statute adds. The statute lets the parent's signature be acknowledged before a notary public or two witnesses, as quoted above.^[1.2] CS-0817 itself prints only the notary blocks.^[2]

The FormsPal template from Create My Document. The template is a separate FormsPal document, not CS-0817. Tennessee law requires the power of attorney for care of a minor child to be executed in writing on a form provided by the Department of Children's Services.^[1.1]

What You Need Before You Start

Gather a few details before you fill out CS-0817, so you can finish it in one sitting. The form asks for these.^[2]

• The child's full name.
• The name and address of the mother or legal guardian, and of the father or legal guardian.
• The caregiver's name and address.
• Which statement in item 5 fits your family. If one parent has legal custody and the other parent does not sign, item 5 refers to sending that parent a copy of the document and a notice by Certified Mail, Return Receipt requested, or to a short explanation of why consent cannot be obtained.
• The hardship that makes the power of attorney necessary.
• The powers you give the caregiver, and any additional power you want to write in.
• A notary public for each signer. Page 4 has a notary block for the mother or legal guardian, the father or legal guardian and the caregiver.

How to Fill Out the Tennessee Minor Child Power of Attorney Form

The PDF this page hands out is the Tennessee Department of Children's Services form CS-0817, Power of Attorney for Care of a Minor Child, Rev. 07/18.^[2] It has five pages and three parts: Part I for the parent or parents, Part II for the caregiver and Part III for both. Page 4 holds the signing blocks. You can type your entries with the FormsPal PDF editor or print the form and write by hand. In the fillable PDF, all the initial boxes share one field, so initials typed in one box show up in every box. Leave them empty on screen and write each set of initials by hand after you print. The 13 steps below follow the form in order and use its own labels.

The screenshots under each step show CS-0817, the official Tennessee form, with sample entries in blue, so you can see where each answer goes. The names, addresses and dates are examples only. The signature lines, the NOTARY PUBLIC lines and the My commission expires lines are left empty.

1. Part I, 1. Minor Child's Name (page 1). Part I is for the parent or parents. Print the child's full name.

   

2. 2. Mother/Legal Guardian's Name & Address (page 1). Write the name and address of the mother or legal guardian on the three lines.

   

3. 3. Father/ Legal Guardian's Name & Address (page 1). Write the name and address of the father or legal guardian the same way.

   

4. 4. Caregiver's Name & Address (page 1). Write the name and address of the adult who will care for the child.

   

5. 5. Parents and legal custody (pages 1 and 2). Mark the one statement that fits. Both parents are living, have legal custody and have signed. One parent is deceased. One parent has legal custody and both parents have signed and consent to the caregiver. Or one parent has legal custody and has sent the other parent, by Certified Mail, Return Receipt requested, a copy of the document and a notice of § 34-6-305, or the other parent has not consented. With the last statement, write why consent cannot be obtained on the line at the top of page 2.^[2]

   

6. 6. Type of hardship (page 2). Check at least one: the serious illness or incarceration of a parent or legal guardian, a physical or mental condition that keeps the child from getting care and supervision, the loss or uninhabitability of the child's home after a natural disaster, the parent's or legal guardian's need for medical or mental health treatment, including substance abuse treatment, or other, which you describe on the lines.^[2]

   

7. 7. Authority for the caregiver (page 2). Mark the first box to authorize the caregiver, then mark each power you give: enroll the child in school and extracurricular activities, obtain medical, dental and mental health treatment, and provide for the child's food, lodging, housing, recreation and travel. To give a power the form does not list, mark the last box and write it on the line.^[2]

   

8. 8. and 9. Legal custody and ending the document (page 2). Mark both statements. Item 8 says the document does not give the caregiver legal custody, and that to overrule the caregiver you must revoke the power of attorney in writing and give written documentation to the health care provider and the school. Item 9 says the document may be ended by another written document signed by either parent with legal custody, or by a court order.^[2]

   

9. Part II, 10. to 14. (pages 2 and 3). The caregiver initials each of five statements: the right to enroll the child in the local school, no legal custody, the school may ask for proof of residence or of the hardship before enrollment, the rights and duties under Title 49 that would otherwise go to the parent, and the duty to tell everyone who has a copy if the child stops living with the caregiver.^[2]

   

10. Part III, 15. (page 3). The parents and the caregiver each initial item 15, about paying back the school district if a child is enrolled through a false statement about residence or hardship. Under it, the form states that the signers declare under penalty of perjury under the laws of the State of Tennessee that the form is true and correct.^[2]

    

11. Mother/Legal Guardian (page 4). The mother or legal guardian signs and dates the first block and personally appears before a notary public. The block then has lines for the county, the signer's name, the day, month and year of the appearance, the NOTARY PUBLIC signature and My commission expires.^[2]

    

12. Father/Legal Guardian (page 4). The father or legal guardian does the same in the second block. Leave it blank if the father or legal guardian does not sign the form.

    

13. Caregiver (page 4). The caregiver signs and dates the third block and personally appears before a notary public. The block has the same notary lines.^[2]

    

Page 5 is a notice to the school and the health care provider about relying on the power of attorney. It has nothing to fill in.^[2]

How to Sign and Use the Tennessee Minor Child Power of Attorney

Once the form is filled out, four short steps turn it into a document the agent can use. These steps are practical advice from FormsPal, not legal requirements. Adjust them to fit your family and the people who will rely on the document. Please check with a Tennessee attorney if you have a court order or any doubt.

1. Print a clean copy. Download CS-0817 from this page, fill it in, then print it so everyone signs the same pages.
2. Sign it. On CS-0817, each signer signs a block on page 4 and personally appears before a notary public, as the block states.^[2] Tennessee law requires the parent's signature to be acknowledged before a notary public or two witnesses.^[1.2]
3. Give copies to the agent. Also share a copy with people who may ask to see it, such as the child's school and medical providers.
4. Keep the original safe. Store it where you can find it when needed.

Need a different document? FormsPal also has a Tennessee durable power of attorney and a Tennessee motor vehicle power of attorney form.

Frequently Asked Questions

These answers come from Tennessee's minor child power of attorney statute, Tenn. Code Ann. § 34-6-302, and from DCS form CS-0817. They cover the basics only. For advice about your own situation, such as a custody order, speak with a Tennessee attorney.

What is a minor child power of attorney in Tennessee?

It is a written document in which a parent delegates temporary care-giving authority over a minor child to an adult. A parent can use it when hardship, such as a serious illness, prevents the parent from caring for the child, and no court approval is needed.^[1.1]

How do I get a power of attorney for a child in Tennessee?

The statute sets out three parts:

• The parent delegates the authority in writing, on a form provided by the Department of Children's Services, to an adult residing in Tennessee.^[1.1]
• The parent signs the power of attorney.^[1.2]
• The signature is acknowledged before a notary public or two witnesses.^[1.2]

That form is CS-0817, the PDF on this page.^[2]

Does a Tennessee minor child power of attorney need court approval?

No. The statute says the authority may be delegated without the approval of a court.^[1.1]

Who can be the agent on a Tennessee minor child power of attorney?

Any adult person residing in Tennessee can be the agent.^[1.1]

Does a Tennessee minor child power of attorney need a notary or witnesses?

The parent signs it. The signature must then be acknowledged before a notary public or two witnesses. Witnesses sign and date their signatures at the same time and in each other's presence.^[1.2] CS-0817 prints a notary block for each signer and no lines for witnesses.^[2]

General information, not legal or tax advice.

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Sources

1. Tenn. Code Ann. § 34-6-302.
   • 1.1 § 34-6-302(a)(1)
   • 1.2 § 34-6-302(b)
2. Tennessee Department of Children's Services, Power of Attorney for Care of a Minor Child, form CS-0817, Rev. 07/18, the PDF this page hands out.

Mara Erlach

Writer & Attorney

Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.