Temporary Custody Form

Temporary Custody Form
Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Children Information
Temporary Guardian(s) Information
I,   First Name   Last Name   , hereby grant temporary guardianship of the above children, whom I have legal custody of to the temporary guardian(s) specified above;
From      Date    to   Date   .
       Date.
In the event of an emergency or non-emergency situation requiring medical treatment, I hereby grant permission for any and all medical and/or dental attention to be administered to my child/children.I grant permission for the guardian(s) named above to make educational decisions for my child/children.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: