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Affidavit of Guardianship (Temporary) Template
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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: _________________________________
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Affidavit of Guardianship (Temporary) Template
AFFIDAVIT OF GUARDIANSHIP (TEMPORARY) TEMPLATE FAQ
What is an affidavit of temporary guardianship?
An Affidavit of Guardianship (Temporary) is a sworn statement used to document that a parent or legal guardian is authorizing another adult to temporarily care for a child. It may be used for school enrollment, medical care, travel, or emergency situations, depending on local rules and what third parties require.
Is this the same as court-ordered guardianship?
No. This affidavit is not a court order and may not transfer legal custody permanently. Some situations require a court petition for guardianship, especially for long-term arrangements or where parents cannot consent.
What powers can the temporary guardian have?
The parent can authorize limited powers such as day-to-day care, school decisions, medical consent, and travel. This template includes selectable authority and clear start/end dates so the scope stays limited.
Does it have to be notarized?
Often yes. Many schools and medical providers prefer notarized documents. Some jurisdictions also require witnesses. This template includes a notary section and an optional witnesses section.
When should you use this document instead of a power of attorney?
Use it when you specifically want a sworn statement format (an affidavit) rather than an authorization form. If you want a more detailed delegation of authority, a Guardianship Power of Attorney may be more appropriate. This template is designed as a sworn declaration with clear caregiver authority.
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