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Parental Consent / Authorization for Guardianship of a Minor Template
Authorize a trusted caregiver to act for a minor with clear parental consent and defined limits using this Guardianship Authorization Template.
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Parental Consent / Authorization for Guardianship of a Minor Template
Date: [Date]
Effective Date: [Effective Date]
Expiration Date: [Expiration Date]
1. Parent/Legal Guardian Information
Parent/Guardian #1:
1.1 Full Name: [Name]
1.2 Address: [Address]
1.3 Phone/Email: [Contact]
1.4 Relationship to Child: ☐ Mother ☐ Father ☐ Legal guardian ☐ Other: [Relationship]
Parent/Guardian #2 (if applicable):
1.5 Full Name: [Name]
1.6 Address: [Address]
1.7 Phone/Email: [Contact]
1.8 Relationship to Child: ☐ Mother ☐ Father ☐ Legal guardian ☐ Other: [Relationship]
2. Minor (Child) Information
2.1 Full Legal Name: [Child Name]
2.2 Date of Birth: [MM/DD/YYYY]
2.3 Current Address: [Address]
2.4 School/Program (Optional): [Name]
3. Proposed Guardian (Authorized Caregiver)
3.1 Full Name: [Guardian Name]
3.2 Address: [Address]
3.3 Phone/Email: [Contact]
3.4 Relationship to Child: [Relationship]
4. Scope of Guardianship Authorization
4.1 We authorize the Guardian to provide day-to-day care and supervision for the child during the term stated below.
4.2 Powers Granted (Select All That Apply):
☐ Enroll the child in school and sign school forms
☐ Access school records and attend meetings
☐ Arrange childcare and extracurricular activities
☐ Consent to routine medical, dental, and vision care
☐ Consent to emergency medical treatment and hospital admission
☐ Obtain and share medical records for treatment
☐ Travel with the child as described in Section 5
☐ Other limited authority: [Describe]
4.3 Limits/Restrictions (Optional): [Any limits on travel, medical decisions, locations, or providers.]
5. Travel Authorization (Optional)
5.1 Destinations: [Countries/Cities/States].
5.2 Travel Dates: From [Start Date] to [End Date].
5.3 Travel Notes (Optional): [Flights, lodging, passport details].
6. Custody Statement (Optional)
6.1 Custody status: ☐ Joint custody ☐ Sole custody ☐ Other: [Explain].
6.2 Court order (if any): [Court, date, case number]. ☐ Attached.
7. Term and Revocation
7.1 This authorization begins on the Effective Date and ends on the Expiration Date above, unless revoked earlier in writing.
7.2 We may revoke this authorization at any time by providing written notice to the Guardian and any relevant school/medical provider.
8. Reliance by Third Parties
8.1 Third parties may rely on this authorization unless they have actual knowledge it has been revoked or expired, to the extent permitted by law.
Signatures
Parent/Guardian #1: [Full Name]
Date: [Date]
Signature: ___________________________
Parent/Guardian #2 (if applicable): [Full Name]
Date: [Date]
Signature: ___________________________
Authorized 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 (Optional)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Parent/Guardian Name(s)], known to me (or satisfactorily proven) to be the person(s) whose name(s) are subscribed to this document, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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Parental Consent / Authorization for Guardianship of a Minor Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
PARENTAL CONSENT / AUTHORIZATION FOR GUARDIANSHIP OF A MINOR TEMPLATE FAQ
What is a parental consent for guardianship of a minor?
A Parental Consent / Authorization for Guardianship of a Minor is a document where a parent (or legal guardian) gives written permission for another adult to care for a child and make limited decisions on the parent’s behalf. It can be used for temporary caregiving, school matters, medical care, and travel, depending on what you authorize.
Is this the same as court-ordered guardianship?
No. This document is a private authorization and may not create legal guardianship in the court sense. Some situations require a court process, especially for long-term guardianship, interstate matters, or when parents cannot consent.
What powers can be granted to the guardian?
You can grant day-to-day care, educational decisions, routine and emergency medical consent, and travel permissions. This template includes checkboxes so you can choose and limit the authority.
Do both parents need to sign?
Often yes if both parents have legal custody, unless one parent has sole legal custody or the other parent is unavailable and local law allows one-parent consent. This template includes a custody section to explain the situation and attach supporting documents.
Does it need to be notarized?
Not always, but notarization is commonly recommended and sometimes required by schools, medical providers, or travel authorities. This template includes optional witnesses and notary sections.
How long can the authorization last?
Many jurisdictions limit the duration of temporary guardianship authorizations. This template includes start and end dates so the arrangement is clearly temporary.
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