Temporary Child Guardian Consent Form printable pdf download

TEMPORARY CHILD GUARDIAN CONSENT FORM

The Parent(s)/ Guardian(s)

Full Name(s) and Surname(s): ________________________________and _________________________

Address: _____________________________________________________________________________

_____________________________________________________________________________________

Contact Phone Number(s) and Details: _____________________________________________________

_____________________________________________________________________________________

The Child(ren)

Full Name(s) and Date of Birth: ___________________________________________________________

_____________________________________________________________________________________

The Temporary Guardian(s)

Full Name(s) and Surname(s): ______________________________and ___________________________

Address: _____________________________________________________________________________

_____________________________________________________________________________________

Contact Phone Number(s) and Details: _____________________________________________________

_____________________________________________________________________________________

I / We, the parents or guardians of the child hereby grant temporary guardianship to the Temporary

Guardian for the period from the ___ day of _______, 20__ and expiring on the ___ day of ______,

20__.

•

I /We hereby acknowledge that the child will reside and may travel with the Temporary

Guardian.

•

I / We authorize the Temporary Guardian to act on my/our behalf in making all decisions on a

daily basis as to the child’s activities and wellbeing.

•

I / We authorize the Temporary Guardian to administer general first aid treatment for minor

injuries or illnesses experienced by the child except where any such first aid treatment is

specifically excluded hereunder: ___________________________________

•

I /We authorize the Temporary Guardian, in the event that I / We low case cannot be contacted

or if any urgency dictates, to act in loco parentis for the child in respect of any circumstances,

including any accident or illness, which may necessitate medical treatment, including surgery,

Temporary Child Guardian Consent Form