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.
I, undersigned, also agree with the following statements:
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Clear
Should be Empty: