Temporary Guardianship Agreement Template
This Temporary Guardianship Agreement (the “Agreement”) is entered into on [Effective Date], by and between:
Parent(s)/Legal Guardian(s): [Full Names], residing at [Address]
and
Temporary Guardian: [Full Name], residing at [Address].
Child Information:
• Full Name of Child: [Child’s Name]
• Date of Birth: [DOB]
Parent’s phone: [Parent’s Phone Number]
Temporary Guardian’s phone: [Guardian’s Phone Number]
Alternate Contact: [Name/Phone/Email]
2. Duration
2.1 Start Date: [Start Date]
2.2 End Date: [End Date]
2.3 Parent Early Termination Notice: [Notice method]
3. Grant of Temporary Guardianship
3.1 Delegation: Parent(s) grant Temporary Guardian authority for care and decision-making for the child during the duration.
3.2 Core Decisions: Daily care, medical treatment, education, and general welfare, subject to limitations below.
4. Corrective Boundaries and Spending Controls [Module]
Category | Authorized Spend Limit | Approval Required From Parent? | Payment Method | Notes/Receipts Location |
[Medical co-pays] | $[Amount] | [Yes/No] | [Card/cash/other] | [Folder/Link] |
[School fees] | $[Amount] | [Yes/No] | [Method] | [Folder/Link] |
[Travel/overnight costs] | $[Amount] | [Yes/No] | [Method] | [Folder/Link] |
Category | Authorized Spend Limit | Approval Required From Parent? | Payment Method | Notes/Receipts Location |
[Medical co-pays] | $[Amount] | [Yes/No] | [Card/cash/other] | [Folder/Link] |
[School fees] | $[Amount] | [Yes/No] | [Method] | [Folder/Link] |
[Travel/overnight costs] | $[Amount] | [Yes/No] | [Method] | [Folder/Link] |
Category
Authorized Spend Limit
Approval Required From Parent?
Payment Method
Notes/Receipts Location
[Medical co-pays]
$[Amount]
[Yes/No]
[Card/cash/other]
[Folder/Link]
[School fees]
[Method]
[Travel/overnight costs]
5. Medical Authorization
5.1 Emergency Treatment: Temporary Guardian may consent to emergency evaluation and treatment.
5.2 Non-Emergency Treatment: Temporary Guardian may consent to routine care as needed.
5.3 Medical Notes: [Allergies/medications/provider info/N/A]
6. Education and Activities
6.1 School Authority: Temporary Guardian may [enroll/access records/approve activities] as needed.
6.2 Transportation Authority [If Any]: [School pick-up list/driver permissions/N/A]
7. Parental Rights
7.1 Retained Rights: This Agreement does not terminate parental rights.
7.2 Parent Access to Child: [Visitation/communication expectations]
8. Governing Law
8.1 This Agreement shall be governed by the laws of the State of Texas.
Signatures
Parent/Legal Guardian: _________________________ Date: ____________
Printed Name: ___________________________
Parent/Legal Guardian [If Applicable]: _________________________ Date: ____________
Temporary Guardian: _________________________ Date: ____________
Printed Name: ______________________________
Caregiver/Household Co-Sign [Optional]: _________________________ Date: ____________
Category | Authorized Spend Limit | Approval Required From Parent? | Payment Method | Notes/Receipts Location |
[Medical co-pays] | $[Amount] | [Yes/No] | [Card/cash/other] | [Folder/Link] |
[School fees] | $[Amount] | [Yes/No] | [Method] | [Folder/Link] |
[Travel/overnight costs] | $[Amount] | [Yes/No] | [Method] | [Folder/Link] |