Guardianship Authorization Form printable pdf download

Guardianship Authorization Form

Courtesy of

Affordable ASA Company

P.O. BOX 727 Montrose, CA 91021

Tel: 323-662-9787 eFax: 323-662-1569

Guardianship Authorization Form

I, ______________________________________, parent or legal guardian of

(minor's name) _____________________________, born on __________________,

hereby appoint (guardian's name) _____________________________, to act

on my behalf in any and all matters affecting the conduct, health and well-being of the

above designated minor.

Number where parent can be reached ______________________________

Family doctor _________________________________ Phone __________________

Signature of parent

Date

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

By accepting temporary guardianship, I agree to oversee this minor during

mealtimes, school breaks, and rest and recreation time. I also agree to oversee

the above designated minor if he/she is dismissed for the day before the parent

returns. In other words, I agree to be legally responsible for this minor AT ALL

TIMES, on and off the job, in his/her parent's absence, until minor is reclaimed

by parent or other legal guardian.

Signature of appointed guardian

Date

Affordable ASA Co. P.O. Box 727 Montrose, CA 91021 (323)662-9787

Studio Teachers, Baby Nurse, Medics, Lifeguards, Stand-by Ambulance, Set Security & Police

Serving the Entertainment Industry at Affordable Prices

Guardianship Authorization Form