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Authorization of Temporary Guardianship:

I, ________________________________ (parent’s name) the Parent of _______________________________

(child’s name) hereby grant temporary guardianship to ________________________________

(guardian’s name) for the period from the _______ day of ____________________ 20____ and expiring

on the _______ day of _____________________ 20____.

I also approve of my Child participating in the ____________________________ (event name) on

______________ (date). I authorize the Temporary Guardian to act on my behalf in making all

decisions on a daily basis as to the Child's activities.

PARENT INFORMATION TEMPORARY GUARDIAN

Full Name: _____________________________ Full Name: _____________________________

Phone: _____________________________ Phone: _____________________________

Email: _____________________________ Email: _____________________________

CHILD INFORMATION

Full Name: _____________________________