![]() I hereby grant my full permission and consent for the temporary guardian to establish a place of residence for my child, and for my child to reside and travel with said temporary guardian.ģ. I hereby declare that I have legal custody of the above named child.Ģ. Home phone: _ Work phone: _Ĭell phone: _ Pager: _Īdditional Contact Information: _ĪUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S)ġ. Note any other significant medical information:ĭentist's Name: _ĭentist's Address: _ĭentist's Office Phone: _ Dentist's Emergency Phone: _ĭentist's Insurer/Health Plan: _ Policy #: _ If applicable, please note the conditions for which the child is currently receiving treatment: ![]() Medical Insurer/Health Plan: _ Policy #: _Īllergies to Medications: _Īllergies (Other): _ In some circumstances, a court may need to approve the temporary guardianship arrangement, and in such cases, consulting an attorney may be advisable.ĪUTHORIZATION FOR TEMPORARY GUARDIANSHIP OF MINORįull Legal Name: _ĭate of Birth: _ Age: _ Gender: _ĭoctor's Name: _ĭoctor's Address: _ĭoctor's Office Phone: _ Doctor's Emergency Phone: _ Temporary guardianship refers to a limited and temporary transfer of parental responsibilities to another individual, while full guardianship involves a more permanent transfer of legal custody and control over the child. ![]() Please note that temporary guardianship is distinct from full guardianship. They can attach a certificate of acknowledgment or use the one provided within the form. Finally, a notary public or other officer must verify the identity of the individuals who will sign the document. The parent(s) or legal guardian(s) must sign the form, in addition to the temporary guardians, in which they acknowledge their responsibilities and agree to the terms. This section includes information about the start and end dates of the guardianship, as well as the allocation of financial responsibility associated with the child's care. The form includes a section in which the parent(s) or legal guardian(s) provide their authorization and consent for the temporary guardianship arrangement. The form also includes information about the child's parents or legal guardians, the temporary guardians, and an emergency contact. The form collects information about the child, including the child's full legal name, date of birth, age, and gender, as well as information about the child's medical and dental providers. The form provides a written record of the arrangement and defines the responsibilities and limitations of the temporary guardian in caring for the child. This may occur in a variety of circumstances, such as when the parent or legal guardian is unable to care for the child due to work obligations, travel, illness, or other reasons. This form is appropriate for use when a parent or legal guardian of a minor child wishes to appoint temporary guardianship to another individual or individuals for a specific period of time. This document is an Authorization for Temporary Guardianship of a Minor.
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