Emergency Guardianship Consent Letter

Date:

To Whom It May Concern,

I, , parent/legal guardian of , born on , hereby authorize to act as temporary guardian in my absence. This authorization is valid during the period from to .

Temporary Guardian's Information:

Name:

Relationship to child:

Address:

Phone Number:

Child's Information:

Name:

Date of Birth:

Address:

The temporary guardian is authorized to make decisions regarding medical care, school matters, and general welfare for my child during this time.

Parent/Guardian Signature

Printed Name

Date