Temporary Guardianship Agreement
I,(parent‘s name here), of (parent's address here), as the custodial parent of:
(child‘s name here), DOB
do hereby grant temporary custody of the above listed child to:
(Your name here)
Mr. and Mrs. (last name here) current address is (address here).
Statement of Consent: (To be signed in the presence of a legalized notary public.)
I, (parent‘s name), hereby grant temporary custody of the above child, whom I have legal custody of, to (your name here):
____ From ________________ to ________________.
____ For as long as necessary, beginning on___________________.
In addition, in the event of an emergency or non-emergency situation requiring medical treatment, I hereby grant permission for any and all medical and/or dental attention to be administered to my child, in the event of an accidental injury or illness, until such time as I can be contacted. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and the administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel.
Further, the above named guardians shall have the right to enroll the minor child in any school and have the right to monitor his academic progress and tend to any educational needs that may present themselves.
Signature: _______________________________________________ Date:_________________
Notarization:
On this __________ day of ___________ , 2008, (parent’s name here) personally appeared before
(date) (month)
Me in ___________________ County in the state of (your state) and in my presence, signed this
Temporary Guardianship form.
Name of Notary Official:_________________________________________________________
Signature:____________________________________________________________________
Commission Expires:___________________________________________________________
