N.Y. GOB Law § 5-1552

§ 5-1552. Form of designation. 1. Designations in general. A\ndesignation of a person in parental relation pursuant to this title\nshall be in writing and shall include: the name of the parent, the name\nof the designee, the name of each minor or incapacitated person with\nrespect to whom such designation is made, the parent's signature, and\nthe date of such signature. The designation may specify a period of time\nless than twelve months for which such designation shall be valid unless\nearlier revoked by such parent pursuant to section 5-1554 of this title,\nprovided that any designation specifying a period of more than thirty\ndays shall also conform to the provisions of subdivision two of this\nsection.\n 2. Designations for more than thirty days. A designation specifying a\nperiod of more than thirty days shall also include: an address and\ntelephone number where the parent can be reached, an address and\ntelephone number where the designee can be reached, the date of birth of\neach minor or incapacitated person with respect to whom such designation\nis made, the date or contingent event on which the designation\ncommences, the written consent of the designee to such designation, and\na statement that there is no prior order of any court in any\njurisdiction currently in effect prohibiting such parent from making the\ndesignation. A designation specifying a period of more than thirty days\nshall be notarized.\n 3. Designations not specifying a time period. If no time period is\nspecified in a designation, it shall be valid until the earlier of\nrevocation or the expiration of thirty days from the date of signature\nif the designation does not meet the requirements of subdivision two of\nthis section, or twelve months from the date of commencement specified\ntherein if the designation meets the requirements of subdivision two of\nthis section.\n