Guardianship Plans printable pdf download

FORM 6D

GUARDIANSHIP PLANS

As prospective adoptive parent/s, I/we _________________________________________________

Adoptive Applicant Name/s)

understand the importance of planning for my/our child's future. In the unlikely event that I/we can no

longer provide support and care for our child, I/we have identified the following family to provide

guardianship care of my/our child until the child's 18th birthday:

Guardian Name(s):

___________________________________________

Guardian Address:

___________________________________________

Guardian Telephone:

____________________________________

Children in the Guardian home (names and ages):____________________________________________

____________________________________________________________________________________

Occupation of Guardians: _______________________________________________________________

____________________________________________________________________________________

Guardian’s relationship to Adoptive Parent(s):

_____________________________________________________________________________________

_____________________________________________

__________________

Guardian 1 Signature

Date

_____________________________________________

__________________

Guardian 2 Signature

Date

I/We have discussed guardianship plans with the above named family and they are aware of the social,

emotional and financial obligations associated with this plan. The above named family is fully accepting

of the responsibilities associated with providing guardianship care.

In consultation with my/our agency and social worker, it is our understanding that the above named

family would be considered appropriate under my/our child's country-of-origin adoption regulations.

_____________________________________

Applicant 1 Signature

Applicant 2 Signature

___ (Initials) I certify that I have retained a copy of this signed document for my own records.

Guardianship Plans