Sanctuary Christian Fellowship Temporary Guardianship Agreement printable pdf download

Temporary Guardianship Agreement

I, ________________________________

, as the custodial guardian of:

(child’s permanent guardian)

Child 1: ______________________________________ Child 1’s DOB: _______________

Child 2: ______________________________________ Child 2’s DOB: _______________

Child 3: ______________________________________ Child 3’s DOB: _______________

(if temporarily transferring guardianship of more than three children, list their names and dates of birth on the reverse side)

do hereby grant temporary guardianship of the above listed children to:

(list the full names of the individual(s) to whom you are granting temporary custody)

Person 1: ____________________________________________________________________

Relationship to child(ren): __________________________________________

Phone number: ________________________

Address: ________________________________________________________

Person 2: ____________________________________________________________________

Relationship to child(ren): __________________________________________

Phone number: ________________________

Address: ________________________________________________________

____from _________________________

to __________________________

(beginning date)

(end date)

____for as long as necessary beginning on ____________________________

(beginning date)

In addition, in the event of an emergency or non-emergency situation requiring medical treatment, I hereby

grant permission for any and all medical and/or dental attention to be administered to my child(ren), in the

event of an accidental injury or illness. This permission includes, but is not limited to, the administration of

first aid, the use of an ambulance, the administration of anesthesia, and/or surgery, under the recommendation

of qualified medical personnel. I also grant permission for the guardians(s) named above to make educational

decisions for my child(ren).

Permanent Guardian signature: ___________________________________________ Date: _______________

Temporary Guardian signature: ___________________________________________ Date: _______________

Designated Third Party signature: _________________________________________ Date: _______________

3600 S. Clarkson St., Englewood, CO 80113 Office: 720.440.3531 info@scf.church

A community committed to carrying out the revolution of Jesus.

Sanctuary Christian Fellowship Temporary Guardianship Agreement