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Authorization for Temporary Guardianship of Minor

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					This Authorization for Temporary Guardianship of a Minor is executed by the natural
parents or legal guardian of a minor, whereby authorization is given to a certain
individual(s) for temporary guardianship. The authorization also provides that the
individual(s) can make educational decisions for the minor and seek and obtain medical
and dental treatment if necessary. This form should be used by parents and legal
guardians who wish to grant temporary guardianship to another individual(s).
                                           Authorization for Temporary Guardianship of Minor




     AUTHORIZATION FOR TEMPORARY GUARDIANSHIP OF
                        MINOR
       I/WE THE UNDERSIGEND, DO HEREBY DECLARE that I/we are the natural
parent(s) and have legal custody of my/our minor child ______________________, whose date
of birth is _______________________________. My/our contact particulars are attached
annexed hereto as Schedule “A”.

1.     I/we hereby authorize and grant temporary guardianship over my/our minor child
       ________________ to _________________________.

2.     My/our minor child _________________________ will be temporarily residing with
       ___________________ at their residence located at ____________________, telephone
       number _______________. My/our minor child will commence his/her/their temporary
       residence with ________________ on or about the _____ day of _______________,
       2_____ until on or about the ____ day of ______________, 2_____.

3.     I/we hereby authorize ____________________ to travel with my/our minor child
       _____________ within the city/state/country of _____________ while my/our minor
       child ______________ is temporarily residing with ______________.

4.     I/we hereby authorize and grant to ________________ to make any and all required and
       necessary decisions for my/our minor child ___________ while he/she/they are
       temporarily residing with __________. Such decisions shall include but not be limited
       to, decisions in respect to education, activities, medical treatment, both emergency and
       non-emergency treatment and dental treatment, both emergency and non-emergency
       treatment.

5.     I/we hereby authorize and grant to ______________ to administer first aid treatment to
       my/our minor child ____________. In the event my/our minor child _________
       encounters a life threatening injury or sickness during his/her/their temporary residence
       with ______________, I/we hereby further authorize and grant _____________ to
       authorize any and all emergency personnel to attend to and treatment my/our minor child
       __________, and to issue his/her consent to all medical testing and treatment that may be
       required or deem advisable by a properly licensed and qualified physician, surgeon or
       dentist.

6.     This authorization shall be in effect as of the ____ day of ____________, 2____ and shall
       cease on the ____ day of __________, 2____.

7.     In the event that more than one legal guardian exists, the use of the singular shall
       incorporate the plural. In the event that more than one temporary guardian is named, the
       use of the singular shall incorporate the plural.
                                              3


8.    I/we hereby make this authorization and do declare that all information and facts stated
      herein are true and correct as of the date this authorization is executed.


SIGNED, SEALED AND DELIVERED              )
in the presence of:                       )
                                          )
                                          )
                                          )
Notary Public                             )       Parent/Legal Guardian
                                          )
                                          )
                                          )
Notary Public                             )       Parent/Legal Guardian
                    4


              SCHEDULE “A”

PARENT/LEGAL GUARDIAN CONTACT INFORMATION
                                                                     5


				
DOCUMENT INFO
Description: This Authorization for Temporary Guardianship of a Minor is executed by the natural parents or legal guardian of a minor, whereby authorization is given to a certain individual(s) for temporary guardianship. The authorization also provides that the individual(s) can make educational decisions for the minor and seek and obtain medical and dental treatment if necessary. This form should be used by parents and legal guardians who wish to grant temporary guardianship to another individual(s).
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