Grandparent Guardianship Agreement
Date:
Parties
Grandparent(s) Name(s):
Address:
Phone:
Email:
Parent/Legal Guardian Name(s):
Address:
Phone:
Email:
Child(ren) Information
Name
Date of Birth
Relationship to Grandparent
Agreement Details
Effective Date:
Duration of Guardianship:
Specific Powers/Responsibilities Granted:
Medical and Educational Authorization:
Other Terms and Conditions:
Signatures
Grandparent(s) Signature:
Date:
Parent/Legal Guardian Signature:
Date:
Witness Signature (if required):
Date: