Temporary Legal Guardian Appointment Form

Parent(s)/Legal Guardian(s) Name(s):
Child(ren) Name(s) & Date of Birth:
Appointment Of Temporary Guardian
I/We hereby appoint
as the temporary legal guardian of my/our child(ren) listed above.
Guardian's Address:
Guardian's Phone Number:
Duration of Guardianship
This appointment is effective from
to
.
Special Instructions (if any)
Authorization
I/We authorize the above-named guardian to act on my/our behalf in making decisions for my/our child(ren), including but not limited to medical care, education, and general welfare, during the dates specified.
Signature of Parent/Guardian
Date
Signature of Temporary Guardian
Date