Temporary Child Guardianship Authorization
Fill out, print, and notarize. Keep with designated guardian.
TEMPORARY GUARDIANSHIP AUTHORIZATION
POWER OF ATTORNEY FOR TEMPORARY CUSTODY
I, _________________________________________________ (full name of parent/guardian),
residing at: _________________________________________________
_________________________________________________ (city, state, zip)
Hereby authorize:
_________________________________________________ (full name of designated guardian),
residing at: _________________________________________________
Phone: _________________________________________________
To act as temporary guardian of my child/children:
Child 1: _________________________ Date of birth: _____________
Child 2: _________________________ Date of birth: _____________
Child 3: _________________________ Date of birth: _____________
This authorization grants the right to:
- Make decisions about the child's education
- Give consent for medical treatment
- Pick up the child from school/daycare
- Travel with the child within the USA
- Make daily care decisions for the child
Validity period: from _____________ to _____________ (or until revoked)
Parent/Guardian Signature
Date: _____________
Designated Guardian Signature
Date: _____________
NOTARY / NOTARIZATION:
Important: For full legal force, this document must be notarized. Many banks and UPS Stores offer notary services. Cost is usually $5-15.