Guardianship Authorization - Superior Court Of Santa Clara County
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MINOR
Name: ___________________________________________________________
Birthdate: _____________ Age: ______ Year in School __________
MOTHER
Name: ___________________________________________________________
Street Address: _________________________________________________
City: _________________ State: ________ Zip Code: ______________
Home Phone: _____________________ Work phone: __________________
FATHER
Name: ___________________________________________________________
Street Address: _________________________________________________
City: _________________ State: ________ Zip Code: ______________
Home Phone: _____________________ Work phone: __________________
PROPOSED GUARDIAN(S)
Name: ___________________________________________________________
Street Address: _________________________________________________
City: _________________ State: ________ Zip Code: ______________
Home Phone: _____________________ Work phone: __________________
Relationship to minor: __________________________
Name: ___________________________________________________________
Street Address: _________________________________________________
City: _________________ State: ________ Zip Code: ______________
Home Phone: _____________________ Work phone: __________________
Relationship to minor: __________________________
In case of emergency, if proposed guardian cannot be reached, please
contact:_____________________________ Phone: ____________________
Authorization And Consent Of Parent(s)
1.
I affirm that the minor indicated above is my child and that I have legal custody of
her/him. I give my full authorization and consent for my child to live with the proposed
guardian(s), or for the proposed guardian to set a place of residence for my child.
2.
I give the proposed guardian permission to act in my place and to make decisions
pertaining to my child’s educational and religious activities, including, but not limited to
enrollment, permission to participate in activities and consent for medical treatment at
school.
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GUARDIANSHIP AUTHORIZATION
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