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Author Topic: Guardianship Forms  (Read 961 times)

Imom

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Guardianship Forms
« on: Sep 29, 2005, 02:34:59 PM »
Below is a sample form for guardianship I found online.

By brother & sister inlaw want to sign guardianship over to me and my husband.......this form is for temporary and we would like one for permanent. (I do understand that ultimately custody is not permanent----we want to excluded the part where it expires unless they go to court).

We also would like to file this with the Courts this form looks like its only a "power of attorney" sort of thing...........


AUTHORIZATION FOR TEMPORARY GUARDIANSHIP OF MINOR

Child
Full Legal Name: _________________________________________________ ___________
Date of Birth: _______________________ Age: ___________ Gender: ___________


Doctor’s Information
Doctor’s Name: _________________________________________________ _________
Doctor’s Address: _________________________________________________ ___________
Doctor’s Office Phone: ____________________ Doctor’s Emergency Phone: __________________
Medical Insurer/Health Plan: __________________________ Policy #: ______________________
Allergies to Medications: _________________________________________________ ___________
Allergies (Other): _________________________________________________ ___________
If applicable, please note the conditions for which the child is currently receiving treatment:
_________________________________________________ ___________
Note any other significant medical information:
_________________________________________________ ________________________________
_________________________________________________ ________________________________

Dentist’s Information
Dentist’s Name: _________________________________________________ ___________
Dentist’s Address: _________________________________________________ _________________
Dentist’s Office Phone: ____________________ Dentist’s Emergency Phone: _________________
Dentist’s Insurer/Health Plan: __________________________ Policy #:


Parent(s)/Legal Guardian(s):

Parent #1:
Name: _________________________________________________ __________________________
Address: _________________________________________________ ________________________
Home phone: __________________________ Work phone: __________________________
Cell phone: ____________________________ Pager: _______________________________
Email: ________________________________
Additional Contact Information: _________________________________________________ ______
_________________________________________________ ________________________________

Parent #2:
Name: _________________________________________________ __________________________
Address: _________________________________________________ ________________________
Home phone: __________________________ Work phone: __________________________
Cell phone: ____________________________ Pager: _______________________________
Email: ________________________________
Additional Contact Information: _________________________________________________ ______
_________________________________________________ ________________________________


Temporary Guardian(s):

Temporary Guardian #1:
Name: _________________________________________________ __________________________
Address: _________________________________________________ ________________________
Home phone: __________________________ Work phone: __________________________
Cell phone: ____________________________ Pager: _______________________________
Email: ________________________________
Additional Contact Information: _________________________________________________ ______
_________________________________________________ ________________________________

Temporary Guardian #2:
Name: _________________________________________________ __________________________
Address: _________________________________________________ ________________________
Home phone: __________________________ Work phone: __________________________
Cell phone: ____________________________ Pager: _______________________________
Email: ________________________________
Additional Contact Information: _________________________________________________ ______
_________________________________________________ ________________________________


Emergency Contact:
Name: _________________________________________________ __________________________
Address: _________________________________________________ ________________________
Home phone: __________________________ Work phone: __________________________
Cell phone: ____________________________ Pager: _______________________________
Email: ________________________________
Additional Contact Information: _________________________________________________ ______
_________________________________________________ ________________________________


AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S)

1. I hereby declare that I have legal custody of the above named child.

2. I hereby grant my full permission and consent for the temporary guardian to establish a place of residence for my child, and for my child to reside and travel with said temporary guardian.

3. I hereby grant the temporary guardian my full authorization to make all decisions related to my child’s educational, religious, and recreational activities and undertakings.

4. I hereby grant the temporary guardian my full authorization to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the temporary guardian to summon any and all professional emergency personnel to attend, transport, and treat the participant and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur.

5. This authorization is effective commencing on the ______day of ____________________, 20_____ and expiring on the ______day of ____________________, 20____.

6. For the duration that the temporary guardian cares for my child, the costs associated with my child’s maintenance, living expenses, medical, and dental expenses shall be allocated and paid as follows: _________________________________________________ ___________.

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.

Under penalty of perjury under the laws of the state of ______________________, I attest to the truthfulness, accuracy, and validity of the forgoing statement.


Parent 1’s signature: ________________________________ Date: ____________________


Parent 2’s signature: ________________________________ Date: ____________________


CONSENT OF TEMPORARY GUARDIAN

I hereby acknowledge the terms set forth above and agree to assume responsibility in accordance with those terms.
Under penalty of perjury under the laws of the state of ______________________, I attest to the truthfulness, accuracy, and validity of the forgoing statement.


Temporary Guardian 1’s signature: ________________________________ Date: ____________________


Temporary Guardian 2’s signature: ________________________________ Date: ____________________


CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

STATE OF __________________
COUNTY OF ________________

This document was acknowledged before me on ______________________ [date] by ________________________________________________ [name of principal].

[Notary Seal, if any]:  
_______________________________
(Signature of Notarial Officer)

Notary Public for the State of ______________

My commission expires: __________________

My question is;

1. Is there anyway you could help me make this into more of a motion/consent so it looks more proper to file (if you have time that is.)
 


socrateaser

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RE: Guardianship Forms
« Reply #1 on: Sep 29, 2005, 11:29:03 PM »
I'm sorry, but I just don't have time for this request at the moment. You may have noticed that I helped another poster out the other day on a doc request, but his issue was trivial as compared to yours, in terms of the time required.

 

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