Guardianship Form
Adoptive Family Name:
______________________________
Name of Guardian(s):
Guardian's Name:
______________________________
Guardian's Age:
________ years
Guardian's Address:
______________________________
______________________________
Guardian's Occupation:
______________________________
Guardian's Employer:
______________________________
Is this guardian in good health?
________ yes ________ no
Is this guardian financially stable?
________ yes ________ no
Guardian's Spouse's Name:
______________________________
Spouse's Age:
________ years
Spouse's Occupation:
______________________________
Spouse's Employer:
______________________________
Is this spouse in good health?
________ yes ________ no
Is this spouse financially stable?
________ yes ________ no
How long has guardian and spouse married?
________ years
Do they have children? How many? ______________________________
Have the Guardian(s) agreed to be guardian(s): ________ yes ________ no
Explain Guardian's relationship to you (friend or relative?):
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Why have you chosen this person(s) as Guardian(s) for your child?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________