La Scuola Authorization Of Temporary Guardianship Page 2

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THE TEMPORARY GUARDIAN(s)
Full Name and Surname:
Identity / Social Security or Other (Specify) number:
Full Name and Surname:
Identity / Social Security or Other (Specify) number:
Physical Address:
Contact Details:
(hereinafter referred to as "the Temporary Guardian")
I, the Parent / Guardian of the Child hereby grant temporary guardianship to the Temporary Guardian for
the period from the _______ day of ____________________ 20____ and expiring on the
_______ day of _____________________ 20____.
1.
I hereby acknowledge that the Child will reside with the Temporary Guardian and may travel locally
with the Temporary Guardian.
2.
I authorize the Temporary Guardian to act on my behalf in making all decisions on a daily basis as to
the Child's activities.
3.
I authorize the Temporary Guardian to administer general first aid treatment for minor injuries or
illnesses experienced by the Child except where any such first aid treatment is specifically excluded
hereunder:
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