Affidavit of Guardianship (Temporary) Template

State of [State]
County of [County]

I, [Parent/Legal Guardian Full Name], being duly sworn, declare as follows:

1. Parent/Legal Guardian Information

1.1 Full Legal Name: [Name]
1.2 Address: [Address]
1.3 Phone/Email: [Contact]
1.4 Relationship to Child: ☐ Mother ☐ Father ☐ Legal guardian ☐ Other: [Relationship]

2. Child Information

2.1 Child Full Legal Name: [Name]
2.2 Date of Birth: [MM/DD/YYYY]
2.3 Current Address: [Address]

3. Temporary Guardian (Caregiver) Information

3.1 Full Legal Name: [Name]
3.2 Address: [Address]
3.3 Phone/Email: [Contact]
3.4 Relationship to Child: [Relationship]

4. Purpose and Term

4.1 Purpose. This Affidavit is made to authorize temporary caregiving for the child for: ☐ Travel ☐ School matters ☐ Medical care ☐ Emergency caregiving ☐ Other: [Purpose].
4.2 Effective Date. This temporary guardianship begins on [Start Date].
4.3 End Date. This temporary guardianship ends on [End Date], unless revoked earlier in writing.

5. Authority Granted (Select All That Apply)

5.1 I authorize the Temporary Guardian to:
☐ Provide day-to-day care and supervision
☐ Make routine educational decisions (school forms, meetings)
☐ Obtain and consent to routine medical, dental, and vision care
☐ Consent to emergency medical treatment if I cannot be reached
☐ Arrange childcare and activities
☐ Travel with the child as described in Section 6
☐ Other limited authority: [Describe]

5.2 The Temporary Guardian is not authorized to:
☐ Change legal custody ☐ Consent to adoption ☐ Consent to marriage ☐ Other: [Limits]

6. Travel Authorization (Optional)

6.1 Destinations: [Countries/Cities].
6.2 Travel dates: From [Start Date] to [End Date].
6.3 Additional travel details (optional): [Flights, lodging, contacts].

7. Additional Information (Optional)

7.1 Medical Provider: [Name/phone]
7.2 Insurance Information: [Provider/policy]
7.3 Allergies/Medications: [List]
7.4 Emergency Contacts: [Names/phones]

8. Statement of Truth

8.1 I declare under oath that the foregoing is true and correct to the best of my knowledge.

Signatures

Affiant (Parent/Legal Guardian): [Full Name]
Date: [Date]
Signature: ___________________________

Temporary Guardian (Acknowledgment, Optional): [Full Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness #1 Name: [Name]
Date: [Date]
Signature: ___________________________

Witness #2 Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization

Subscribed and sworn (or affirmed) before me on [Date], by [Parent/Legal Guardian Full Name], who is personally known to me or has produced identification.

Notary Public Signature: _______________________
Printed Name: ________________________________
Commission Expires: ___________________________
Notary Seal: _________________________________