Short-term Guardian Appointment Consent Form
Child Information
Child's Full Name
Date of Birth
Parent/Legal Guardian Information
Name
Relationship to Child
Contact Number
Address
Temporary Guardian Information
Name
Relationship to Child
Contact Number
Address
Guardian Appointment Period
Start Date
End Date
Consent
I authorize the above-named individual to act as temporary guardian and provide necessary care, including obtaining emergency medical treatment, for my child during the above period.
Parent/Guardian Signature
Date