Emergency Guardianship Petition Template

[Petitioner Name]
[Address]
[City, State, ZIP Code]
[Phone Number]
[Email Address]

IN THE [NAME OF COURT]
FOR [COUNTY / DISTRICT / JURISDICTION]

In the Matter of:
[Name of Minor or Proposed Ward]

Case No.: [Case Number]

1. Petition

The undersigned Petitioner respectfully asks the Court to appoint an emergency guardian for the person identified in this Petition.

This request is made because immediate court action is necessary to protect the health, safety, welfare, property, or care of the proposed ward or minor until further order of the Court.

2. Petitioner Information

Petitioner Name: [Full Name]
Address: [Address]
City, State, ZIP Code: [City, State, ZIP Code]
Phone Number: [Phone Number]
Email Address: [Email Address]

Relationship to proposed ward or minor:

☐ parent
☐ relative
☐ caregiver
☐ spouse
☐ adult child
☐ agency representative
☐ other: [Describe]

3. Proposed Ward or Minor Information

Name: [Full Name]
Date of Birth: [Date of Birth]
Current Address or Location: [Address / Facility / Shelter / Hospital / Other]

This Petition concerns:

☐ a minor
☐ an adult alleged to need guardianship
☐ the person only
☐ the estate only
☐ both person and estate

Additional identifying information, if applicable:

[Insert details]

4. Proposed Emergency Guardian

The person proposed to serve as emergency guardian is:

Name: [Full Name]
Address: [Address]
Phone Number: [Phone Number]
Email Address: [Email Address]

Relationship to proposed ward or minor:

[Describe relationship]

The proposed emergency guardian is willing and able to serve in this role.

5. Interested Persons

The following persons may have an interest in this matter and should receive notice if required:

[Parent / spouse / adult children / current caregiver / guardian / conservator / other interested person]

Name: [Full Name]
Relationship: [Relationship]
Address: [Address]

Name: [Full Name]
Relationship: [Relationship]
Address: [Address]

Additional interested persons, if any:

[Insert details]

6. Emergency Facts

Immediate emergency circumstances exist because:

[Describe the emergency in clear detail]

Date the emergency arose or was discovered: [Date]

The emergency involves, if applicable:

☐ medical neglect
☐ abandonment
☐ abuse or mistreatment
☐ unsafe living conditions
☐ inability to consent to care
☐ immediate financial risk
☐ need for temporary placement
☐ other urgent concern: [Describe]

7. Need for Immediate Appointment

The proposed ward or minor requires immediate protection because:

[Describe why waiting for the regular guardianship process would likely cause harm, loss, danger, or serious disruption]

The requested emergency appointment is necessary to:

[Describe the urgent need]

8. Related Case or Guardianship Filing

A related guardianship, conservatorship, custody, or protective matter:

☐ has already been filed
☐ is being filed together with this Petition
☐ is not yet filed
☐ other: [Describe]

Related case number, if any: [Case Number]

Additional case details, if any:

[Insert details]

9. Requested Emergency Authority

The Petitioner requests that the Court grant the emergency guardian authority to do the following:

☐ provide consent for medical, dental, or mental health care
☐ decide temporary residence or placement
☐ obtain school, care, or treatment records
☐ protect personal safety and daily care
☐ manage limited financial matters
☐ secure property or personal belongings
☐ communicate with service providers or agencies
☐ other temporary authority: [Describe]

10. Less Restrictive Alternatives

The Petitioner states that the following less restrictive or non-court options have been considered:

[Describe family arrangements, powers of attorney, caregiver support, agency help, or other options]

Those alternatives are not sufficient because:

[Insert explanation]

11. Notice

Notice of this emergency request has been:

☐ given to all required persons
☐ attempted but could not be completed in time
☐ not given for the following emergency reason: [Describe]

Details of notice or attempted notice:

[Insert details]

12. Request for Relief

The Petitioner respectfully requests that the Court:

appoint [Proposed Emergency Guardian Name] as emergency guardian;
grant temporary authority as requested above;
set any further hearing the Court requires;
grant any additional emergency relief the Court considers proper.

Requested effective date of emergency appointment:

[Date]

Requested duration, if applicable:

[Insert number of days or write “until further order of the Court”]

13. Verification

I declare under penalty of perjury that the statements in this Emergency Guardianship Petition are true and correct to the best of my knowledge.

Petitioner Signature: __________________________
Name: [Full Name]
Date: [Date]

14. Proposed Emergency Guardian Acceptance

I agree to serve as emergency guardian if appointed by the Court and to carry out the duties required by law and court order.

Proposed Emergency Guardian Signature: __________________________
Name: [Full Name]
Date: [Date]

15. Notary or Court Verification

State of [State]
County of [County]

Subscribed and sworn to before me on this [Day] of [Month], [Year], by [Name of Signer].

Notary Public Signature: __________________________
Name: [Notary Name]
My Commission Expires: [Date]