TEMPORARY GUARDIANSHIP AUTHORIZATION AGREEMENT
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Effective Date: ________________________________________________________
Place: _________________________________________________________________

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1. Parties to the Agreement
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This Agreement is entered into on ____________________ (____________________) by and between:

Parent / Legal Guardian
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

Temporary Guardian
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS
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Child's Full Name & Date of Birth:
    ____________________________________________________________________
Guardianship Period: ___________________________________________________
Decisions the Guardian May Make:
    ____________________________________________________________________
Where the Child Will Live: _____________________________________________
Parent's Emergency Contact: ____________________________________________

3. EXECUTION & SIGNATURES
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Parent / Legal Guardian

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________

Temporary Guardian

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________