Temporary Guardianship Form

I/we,   Name of Parent(s)  with address at   Street Address   Address Line 2   City   State   Zip   , the custodial parent(s) of   Child's First Name   Child's Last Name , born on   Date of Birth of Child , do hereby appoint by granting temporary guardianship of the aforementioned child to   First Name   Last Name   and   First Name   Last Name . This appointment includes all necessary authority, power, and control in providing care to the aforementioned minor as necessary as possible in desiring providing care to the child's best interest and welfare.

Effectivity

The temporary guardianship shall begin on Date.

Authority of Temporary Guardians

During the period of Temporary Guardianship and In the event that the medical attention is needed for the child, I hereby grant permission for any an all medical and/or dental attention to be administered including administration of first aid, use of ambulance, administration of anesthesia, including surgery under the recommendation of a qualified and licensed medical physician. I also grant permission for the guardian(s) named above to make educational decisions for my/our child. 

Termination

This appointment shall remain effective and cease to terminate in any of the following causes:

1. On   Date   
2. Until I do so revoke this appointment
3. After six months from the date of effectivity of this agreement/appointment
4. Until when the Court renders this agreement/appointment ineffective

Signed and made effective on the   Day1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st day of   MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember,   Year , in   City, State .

ACKNOWLEDGEMENT

State of   State )
County of   County ) S. S.    

Before me, this   Day1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st   day of   MonthType Option 1Type Option 2Type Option 3   ,  Year personally appeared   Name of Parents   , who acknowledged that he/she/they executed the above instrument.

I/we,   Names of Appointed Temporary Guardians, do hereby accept this appointment as guardian(s) for   Child's First Name   Child's Last Name. I/we shall have the responsibility for the care, custody, conduct, control, of the child. I/we likewise agree to provide proper and necessary support and maintenance of the minor child and to abide by all federal, state and local laws. I/we further agree that in case that the child is no longer under our care, we shall promptly notify the school of such information.