Tennessee Power of Attorney Minor Child Form Download: DCS Form CS-0683

If you are looking for the official Tennessee Power of Attorney form for a minor child, you want DCS Form CS-0683 — or the equivalent Tennessee Department of Education template. Both are free, and both satisfy the statutory requirements under T.C.A. § 34-6-301.

Here is where to get them and what matters when you fill them out.

Where to Get the Official Form

The Tennessee Department of Education publishes the Power of Attorney for Care of a Minor Child form on its website. The Department of Children's Services publishes Form CS-0683, which serves the same purpose. Either form works — they both comply with T.C.A. § 34-6-302.

You can also use a private form (not from a state agency) as long as it contains all the statutory declarations and notices required by the Act. But the official forms are designed to include everything, and school registrars and clinic staff recognize them on sight.

What the Form Contains

The standard form has three main parts:

Part I — Parent Information and Hardship

The executing parent fills in their name, address, relationship to the child, and selects at least one hardship ground:

• Serious illness or incarceration
• Physical or mental condition preventing care
• Loss of the child's home from a natural disaster
• Need for medical, mental health or substance abuse treatment
• Other specific hardship (write in the details)

The hardship box is not optional. A form submitted without a checked hardship ground is technically defective, and some districts will reject it.

Part II — Caregiver Information

The caregiver (you) fills in your name, address and relationship to the child, and affirms that you agree to accept responsibility for the child's daily care, school enrollment and medical decisions.

Part III — Joint Declarations

Both the parent and caregiver sign under penalty of perjury that the information is true. The signatures must be witnessed — either by a notary public or by two concurrent adult witnesses who are unrelated to the child, parent and caregiver.

Common Mistakes That Cause Rejection

Missing hardship selection: The most frequent rejection. The parent needs to check at least one box.

Only one parent signed: Both parents with legal custody must sign unless one of the statutory exceptions applies (other parent deceased, sole custody with written consent, or certified mail notice to non-custodial parent).

Witnesses are family members: The two witnesses cannot be related by blood or marriage to anyone involved — not to the child, not to the parent, not to you.

No notarization or witnesses at all: The form must be notarized OR double-witnessed. An unsigned, unwitnessed form is not legally effective.

Using a generic POA template: Some online vendors sell general Power of Attorney forms that do not include the T.C.A. § 34-6-301 hardship declarations. These are different instruments and may not be accepted for school enrollment.

After You Have the Completed Form

Keep the original in a safe place. Make several certified or notarized copies. You will need to give copies to:

• The school registrar when enrolling the child
• The child's pediatrician and dentist
• Any hospital or urgent care facility
• Childcare providers and after-school programs

Store a photo of the completed form on your phone as a backup, but bring the physical copy to enrollment and medical appointments.

The Tennessee School and Medical Consent Guide includes a complete field-by-field walkthrough for executing the form correctly the first time, along with checklists for what to bring to school and medical intake.

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