Temporary Guardianship Enrollment Information printable pdf download

OFFICE USE ONLY

Date: _____________________________

TEMPORARY GUARDIANSHIP

Accepted: ________ Rejected:________

ENROLLMENT INFORMATION

Residency Proof: ___________________

Authorized by: _____________________

Date: ___________________

I certify that I am the parent/legal custodian of _____________________________________________

Student’s Name

Student’s date of birth: ___________________ Age: ______

I authorize and direct ___________________________________________________ to act as guardian for the above named student.

Temporary guardian’s name/relationship to student

Temporary guardian’s address: _____________________________________________ Phone (home): __________________________

_______________________________________________ Phone (work): ___________________________

Phone (cell): ____________________________

The student shall permanently reside at the address of the temporary guardian while attending:

_____________________________________________________

______________

______________________

School

Grade

School Year

Are the parents of the student separated or divorced? Yes _________ No _________

Describe the situation that makes this change in guardianship necessary and indicate the probable length of time the condition will exist.

________________________________________________________________________________________________________________

I understand and intend that said guardian is to assume all of my powers regarding custody, well-being and property of my minor child, which are

delegable under the Colorado Probate Code, including the authorization for emergency medical and dental treatment, for school purposes, and to

receive delivery or payment of money and property due to said minor child. This authority shall remain in effect for a period not to exceed twelve (12)

months or the expiration of the current school year, whichever comes first, unless revoked by me sooner.

Name of parent/legal guardian: __________________________________________________________________________________

____________________________________________________________

____________________

Parent/legal guardian’s signature

Date

Subscribed and sworn before me this _________________________________ Day of ____________________ Year ____________

________________________________________________________

________________________________________________

Notary Public

Address

I hereby acknowledge that I have read and understand the provisions of Section 15-14-105, Colorado Revised Statutes, 2001, and Section 22-1-102,

Colorado School Laws, Revised 2005 (see reverse side of this form). I hereby certify that the student listed above will be in my care and custody and

living in my home (at the temporary guardian’s address listed above) during the limited term of this guardianship, and that I am a resident of the St.

Vrain Valley School District. It is further understood and agreed that the student listed above may be withdrawn from the St. Vrain Valley School

District if the provisions of this guardianship are not complied with as required.

Name of temporary guardian: ___________________________________________________________________________________

_____________________________________________________________