Appointment Of Short-Term Guardian For Minor Child(Ren) And Durable Healthcare Power Of Attorney Page 2
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8and will terminate upon the earlier to occur of (a) the revocation in writing of any parent/guardian, (b) as
required by applicable law, or (c) (check one):
60 days;
on the
day of ,
, 201
; or
the occurrence of the following triggering event(s):
..
Additionally it is my/our intention that, if a court-appointed guardian is required for the child(ren), this
document shall additionally serve as a nomination of the above listed short-term guardians under Probate
Code Section 1502 et seq., who I/we believe will act in the child(ren)’s best interest. If these nominations
are inconsistent with any will I/we have executed, it is my/our intention that these documents be read
together if possible and otherwise that this document control unless it has terminated prior to my/our
death. Until such legal guardianship is established, this short-term guardianship and power of attorney is
intended to be of the person of the child(ren) only, not of their estate(s). It is my/our express intention that
the child(ren) not be taken into government child protective custody or foster care, unless all other short-
term guardian(s) are exhausted and even then I prefer that other relatives assume custody of the
child(ren) unless this box is checked: .
It is my/our intention that this document also qualify as a caregiver authorization affidavit under Section
6550 et seq. of the California Family Code, unless I/we have also attached or simultaneously executed a
statutory Caregiver’s Authorization Affidavit, in which case that/those document(s) shall instead control
with regard to caregiver authorization issues and the documents shall be read together as a harmonious
whole wherever possible.
To the maximum extent permissible under applicable law, the short-term guardian(s) will have the same
authority as I/we would have with respect to the custody and care of the minor child(ren), except as I/we
have specified below, including the right to perform the following acts and make the following decisions,
unless I/we have crossed out and initialed the particular power or otherwise specifically excluded it in
writing in this document or allowing such a power would invalidate this document, in which case only the
offending provisions shall be deemed stricken and ineffective:
To make all emergency and non-emergency healthcare decisions and execute all related
documents including insurance and waiver claims and forms, including the right to approve or
decline medical, dental, eye care, or psychiatric treatment, diagnostic tests, hospitalization, health
care, and personal care, in any situation in which, as the result of illness, disease, absence,
injury, or death I/we are incapable of making or communicating a decision with regard to my/our
child(ren)’s medical or dental care, provided that such decisions are made following consultation
with one or more licensed physicians or other licensed medical practitioners.
I/we further
delegate the power to our short-term guardian(s) to select, employ, and discharge health care
personnel, including dentists and eye care professionals, for our child(ren)’s benefit and to
contract in my/our name and on my/our behalf for all health care services, including emergency
and non-emergency medical, dental, vision, and psychiatric care services and related goods. The
short-term guardian(s) should refer to any Additional Information we have attached to this
document or left with the guardian(s).
To make all decisions, execute all documents, and grant permission regarding the child(ren)’s
education, including but not limited to school enrollment, school and extracurricular activities,
school trips, and school conferences.
To generally do and perform all matters and to execute all documents with respect
to the custody and care of the child(ren) named herein.
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