Temporary Legal Guardianship Consent Form
Child's Information
Full Name
Date of Birth
Address
Parent/Legal Guardian Information
Full Name
Address
Phone Number
Email
Temporary Guardian Information
Full Name
Address
Phone Number
Email
Relationship to Child
Guardianship Period
From (Start Date)
To (End Date)
Consent Details
Specific Powers and Duties Granted to Guardian
Additional Instructions/Information
Emergency Contact
Name
Phone Number
Relationship
Parent/Legal Guardian Signature
Date
Temporary Guardian Signature
Date