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Temporary Guardianship Letter (Sample) Template
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Temporary Guardianship Letter (Sample) Template
Date: [Date]
To Whom It May Concern,
1. Parent/Legal Guardian Information
I, [Parent/Guardian Full Name], am the ☐ mother ☐ father ☐ legal guardian of [Child Full Legal Name], born on [Child Date of Birth].
My address is: [Parent Address].
My phone/email: [Phone] / [Email].
2. Temporary Guardian Information
I authorize [Temporary Guardian Full Name], born on [DOB optional], residing at [Address], phone/email: [Contact], to act as the temporary caregiver for my child.
3. Term of Authorization
This authorization begins on [Start Date] and ends on [End Date], unless revoked earlier in writing.
4. Authority Granted
During the authorized period, I give the Temporary Guardian permission to:
Provide day-to-day care and supervision
Communicate with the child’s school and sign routine school forms
Consent to routine medical care and emergency medical treatment if I cannot be reached
Travel with the child (if applicable): [Destinations/dates]
5. Medical and Emergency Information (Optional)
Child’s doctor/clinic: [Name/phone]
Insurance: [Provider/policy]
Allergies/medications: [List]
Emergency contact: [Name/phone]
6. Additional Notes (Optional)
[Any limitations, special instructions, or custody notes.]
Sincerely,
[Parent/Guardian Full Name]
Signatures
Parent/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 (Optional)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Parent/Guardian Name], known to me (or satisfactorily proven) to be the person whose name is 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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Temporary Guardianship Letter (Sample) Template
TEMPORARY GUARDIANSHIP LETTER (SAMPLE) TEMPLATE FAQ
What is a temporary guardianship letter?
A Temporary Guardianship Letter is a written statement from a parent or legal guardian authorizing another adult to care for a child for a limited period. It is often used for travel, emergencies, school matters, or when parents are temporarily unavailable.
Is this the same as legal guardianship?
No. A letter is usually not a court order and may not transfer legal custody. For longer-term or higher-stakes situations, a court process or a formal power of attorney may be required. This sample is for reference and can be adapted to meet local requirements.
What should the letter include?
Include: parent/guardian and child details, the temporary guardian’s identity, dates of the authorization, what decisions the guardian can make (school, medical, travel), emergency contacts, and a signature. Notarization can help with acceptance, especially for medical or international travel situations.
Should it be notarized?
Not always required, but commonly recommended. Some schools, medical providers, or travel authorities may require notarization. This sample includes an optional notary section.
How long should it last?
Keep it short and tied to a specific timeframe. Many jurisdictions limit how long a temporary guardianship authorization can last without a court order. This sample includes clear start and end dates.
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