Legal Guardianship Consent Form
1. Child Information
Full Name of Child
Date of Birth
Current Address
2. Parent/Legal Guardian Information
Full Name(s)
Relationship to Child
Contact Number
3. Appointed Legal Guardian
Full Name
Relationship to Child
Address
4. Consent
I/We, the undersigned, do hereby consent to appoint the above-named individual as the legal guardian of the minor child identified herein.
Signature of Parent/Legal Guardian
Date
Signature of Appointed Guardian
Date
Witness Name
Signature of Witness
Date