Washington Temporary Guardianship Form: Parent's Power of Attorney for a Minor (RCW 11.130.145)

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Power of Attorney Delegating Parental Powers (Washington)

Temporary Guardianship Form under RCW 11.130.145 and RCW 11.125.410

This power of attorney lets the parent named below delegate powers regarding the care and custody of a child to a trusted adult for a limited time. It is not a court order and does not appoint a guardian; in Washington a guardian of a minor can be appointed only by a court. It delegates only the signing parent’s own powers and does not affect the rights of the other parent or any parenting plan.

1. Parent (Principal)

Name: [Full Legal Name]
Address: [Street, City, Washington ZIP] · Phone: [Phone] · Email: [Email]

Second parent (if also delegating): [Full Legal Name, Address, Phone]

2. Agent (Caregiver)

Name: [Full Legal Name]
Relationship to child: [Grandparent / aunt / uncle / adult sibling / family friend / other]
Address: [Street, City, State ZIP] · Phone: [Phone]

Alternate agent (optional, if the agent cannot act): [Full Legal Name, Address, Phone]

3. Child or Children

Full legal nameDate of birthSchool and gradeAllergies or medical conditions
[Name][Date][School, grade][List, or “None”]
[Name][Date][School, grade][List, or “None”]

4. Term

This power of attorney takes effect on [Start Date] and ends on [End Date], which is not more than twenty-four months after it takes effect (RCW 11.130.145), unless I revoke it earlier.

5. Powers Delegated

Under RCW 11.130.145, I delegate to my agent the following powers regarding the care and custody of my child (check all that apply):

☐ Daily care, supervision and residence of the child with the agent
☐ School matters: enrollment, attendance, conferences, records, permission slips and activities
☐ Extracurricular activities, sports, camps and child care arrangements
☐ Travel with the child within Washington ☐ within the United States (a separate travel consent letter is attached for air travel)
☐ Applying for and receiving benefits for the child
☐ Other: [Describe]

I do not delegate the power to consent to the child’s marriage or adoption, which the law does not allow a parent to delegate. Other limits: [for example, no change of the child’s school district without my written consent].

6. Health Care Decisions (RCW 11.125.410; RCW 7.70.065)

I authorize my agent to make health care decisions, including decisions about mental health care, for my child. This is my signed authorization to make health care decisions for the child within the meaning of RCW 7.70.065(2)(a)(iv). ☐ This authority applies only when I cannot be reached. ☐ This authority applies whenever the child is in the agent’s care.

Except in an emergency, the agent will contact me before consenting to: [for example, non-emergency surgery or new psychiatric medication].

Health insurance: [Insurer, member ID, group number] · Pediatrician: [Name, Phone] · Current medications: [List]

7. Nomination of Guardian (Optional; RCW 11.125.410(2))

If a court needs to appoint a guardian of the person of my child, I nominate [Name] (alternate: [Name]) as guardian, to serve ☐ during my disability ☐ during the child’s minority ☐ until [Date].

[A court appointing a guardian for a minor must appoint a person a parent nominated in a probated will or other record, such as a sworn declaration or power of attorney, unless the appointment is contrary to the child’s best interest (RCW 11.130.215).]

8. Revocation

I may revoke this power of attorney at any time by written notice to the agent. I will also notify the child’s school and health care providers who received a copy.

9. Signatures

Parent: ___________________________ Date: __________
Second parent (if delegating): ___________________________ Date: __________

Acceptance by agent. I accept this delegation and agree to act in the child’s best interest.
Agent: ___________________________ Date: __________

Complete ONE of the following (RCW 11.125.050):

Option A. Notary acknowledgment

State of Washington, County of [County]

This record was acknowledged before me on [date] by [name(s) of parent(s)].

___________________________
Notary Public, State of Washington · My commission expires: [ ]

Option B. Two witnesses

We declare that the parent signed and dated this power of attorney in our presence, and that each of us is competent, is not a home care provider for the parent or a care provider at an adult family home or long-term care facility where the parent lives, and is not related to the parent or the agent by blood, marriage or state registered domestic partnership.

Witness 1: ___________________________ Printed name and address: [ ]
Witness 2: ___________________________ Printed name and address: [ ]

Before You Sign (Delete This Section)

  • Notary or witnesses. Use a notary if you can: a notarized signature is presumed genuine. Witnesses must be unrelated to you and to the agent.

  • 24 months at most. For a longer arrangement, or if you may not be able to resume care, ask the court about a guardianship or a standby guardian (RCW 11.130.220).

  • Parenting plans. If a parenting plan or court order governs the child, check it first: this document cannot give the agent more authority than you have.

  • Give copies. Agent, school, pediatrician and health plan. Keep the original.

  • Travel. For flights, especially international ones, add a separate child travel consent letter signed by both parents.

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Learn more about

Washington Temporary Guardianship Form: Parent's Power of Attorney for a Minor (RCW 11.130.145)

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For quick answers, scroll below to see the FAQ.

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Frequently asked · Washington temporary guardianship

Temporary Guardianship (Washington) · the parent's power of attorney, 24 months, notary or witnesses, medical consent, standby guardians

Eight questions to settle before a relative or friend takes over a child's care in Washington. The state's tool for this is a power of attorney: a parent can delegate care and custody powers for up to two years without a court, and the signing rules come from Washington's power of attorney statute.

01 Basics

Can Washington parents set up a temporary guardianship without going to court?

Not a guardianship: in Washington a person becomes a guardian of a minor only on appointment by a court (RCW 11.130.185). What a parent can do alone is delegate parental powers by a power of attorney, for up to 24 months (RCW 11.130.145).

The power of attorney gives the caregiver the parent's own authority, nothing more. It does not change the other parent's rights or override a parenting plan.

This template is that power of attorney. It carries the name families search for, temporary guardianship, but it says plainly that it is a delegation, not a court appointment.

02 Powers

What can a Washington parent delegate, and for how long?

Any of the parent's powers regarding the care, custody or property of the child, for a period not exceeding 24 months, except the power to consent to the child's marriage or adoption (RCW 11.130.145).

In practice that covers daily care, school matters, activities, travel and health care decisions. Section 5 of the template lets the parent pick the powers and add limits; Section 4 fixes the start and end dates inside the 24-month cap.

03 Signing

Does it need a notary or witnesses in Washington?

One or the other. A power of attorney must be signed and dated by the parent, and the signature must be either acknowledged before a notary or attested by two or more competent witnesses who sign in the parent's presence (RCW 11.125.050).

The witnesses may not be related to the parent or to the agent by blood, marriage or state registered domestic partnership, and may not be the parent's home care providers or care providers at an adult family home or long-term care facility where the parent lives. A signature acknowledged before a notary is presumed genuine, which is why the notary route is the safer one.

04 Medical

Who can consent to a child's medical care in Washington when the parents are away?

RCW 7.70.065(2) sets the order: the appointed guardian or legal custodian; a person authorized by a court for a child in out-of-home placement; the parents; an individual to whom a parent has given a signed authorization to make health care decisions for the child; and a competent adult relative responsible for the child's health care.

A relative can act on their own representation or on a declaration under penalty of perjury, which is valid for six months. Providers may rely on it without further documentation, although they may ask for some, and are immune when they rely on a signed declaration. The template's Section 6 is the parent's signed authorization, which covers caregivers who are not relatives.

05 Medical

What rules apply to a health care agent for a child?

Unless the power of attorney provides otherwise, a parent's authorization for an agent to make health care decisions for a child takes effect when the child has no other parent or legal representative readily available and authorized to consent (RCW 11.125.410(1)).

The template lets the parent choose: authority only when the parent cannot be reached, or whenever the child is in the agent's care. A court-appointed guardian's authority overrides the agent's health care authority only after the guardian has actually been appointed (§ 11.125.410(3)).

06 Planning

Can the power of attorney name a guardian if something happens to the parent?

Yes. A power of attorney may nominate a guardian of the person or estate of a minor child, to serve during the parent's disability, during the child's minority or for a shorter time (RCW 11.125.410(2)). If a will names someone else, the most recent designation controls (§ 11.125.410(4)).

When a court appoints a guardian for a minor, it must appoint a person a parent nominated in a probated will or other record, such as a sworn declaration or power of attorney, unless that appointment is contrary to the child's best interest (RCW 11.130.215). Section 7 of the template is that nomination.

07 Court

What is a standby guardian for a minor in Washington?

A person a parent nominates in a signed record to be appointed by the court. On the petition of a parent or the nominee, the court may appoint a standby guardian if it finds that within two years after the appointment no parent will likely be able or willing to perform parenting functions (RCW 11.130.220).

The standby guardian acts, with a guardian's duties and powers, when no parent is willing or able to exercise them. The parent may state limits on the powers, and may revoke or amend the nomination at any time before the appointment. The petition must be served on each parent and on the child if 12 or older, and anyone served has 60 days to object.

08 Court

When is a court guardianship the better route in Washington?

When the arrangement will last longer than 24 months, or the child needs a guardian that institutions must recognize without question. The court may appoint a guardian for a minor if it is in the child's best interest and each parent, fully informed of the nature and consequences, consents; all parental rights have been terminated; or there is clear and convincing evidence that no parent is willing or able to exercise parenting functions (RCW 11.130.185).

The order must state the rights the parents keep, including contact with the child, unless the court restricts them, and the guardian's letters normally expire on the child's eighteenth birthday (RCW 11.130.215).

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