Temporary Guardianship Agreement (Delegation of Parental Authority)
This Temporary Guardianship Agreement (the “Agreement”) is made between [Parent: full name], of [Parent: address], telephone [Parent: phone] (the “Parent”), and [Guardian: full name], the child’s [Guardian: relationship to child], of [Guardian: address (where the child will live)], telephone [Guardian: phone] (the “Guardian”), concerning [Child: full name], born [Child: date of birth] (the “Child”). The Parent is the parent or legal guardian of the Child with authority to make this delegation. The other parent of the Child is: [Other parent: name and custody status]. The reason for this arrangement is: [Reason for the arrangement]. By this Agreement the Parent delegates to the Guardian, for a limited period, the care and custody of the Child and the powers described below, and the Guardian accepts them.
1. Nature of This Agreement
This Agreement is a delegation of parental authority by the Parent and a private agreement between the Parent and the Guardian. It is not a court order, does not create a legal guardianship, does not terminate or suspend the Parent’s rights, and does not affect the rights of any other parent except to the extent that parent has signed or consented to it. The Parent may revoke it at any time as provided in Section 10. Where the law of the State of [Governing law (state)] limits the period or scope of a delegation of parental authority without court approval, this Agreement is limited accordingly.
2. Period
The Guardian’s authority begins on [Guardianship begins] and ends on [Guardianship ends] (the “Period”), unless ended sooner under Section 10. The Period may be extended only by a new written agreement signed by the Parent, and the Parties intend to sign one before the end date if the arrangement is to continue. The Guardian shall return the Child to the Parent at the end of the Period, or sooner if the Parent so requests.
3. Powers of the Guardian
During the Period the Guardian has the following powers concerning the Child, to be exercised in the Child’s best interest and subject to the limits in Section 4.
(a) Residence and daily care. The Child shall live with the Guardian at the Guardian’s address above. The Guardian shall provide food, shelter, clothing, supervision, transport and the ordinary care a parent provides, and may make day-to-day decisions about the Child’s routine, activities, discipline and companions.
(b) School: [School: enrol, withdraw, sign forms, attend conferences, access records]. If granted, the Guardian may enrol the Child in and withdraw the Child from school and after-school programs, sign enrolment, permission and consent forms, attend conferences, receive report cards and records, consent to evaluations and special education services, and act as the Child’s parent for every school purpose. The Child currently attends [Child’s current school and grade].
(c) Medical and dental care: [Medical and dental care]. The Guardian may consent to that care for the Child by any licensed provider, obtain prescriptions, and receive the Child’s health information. The Guardian shall contact the Parent before any non-emergency treatment beyond routine care, and shall inform the Parent promptly of any illness, injury or treatment.
(d) Travel: [Travel with the child]. The Guardian may travel with the Child within those limits and sign any consent a carrier requires, and shall tell the Parent in advance of any trip away from the Guardian’s home for more than two nights.
(e) Benefits, support and mail: [Receive and manage benefits, support payments and mail for the child]. If granted, the Guardian may receive on the Child’s behalf child support, government benefits, insurance payments and mail, and apply them to the Child’s needs, accounting to the Parent on request.
(f) Incidental powers. The Guardian may sign releases, waivers and consents for the Child’s activities, obtain identification documents and records for the Child, and do every other act reasonably necessary for the Child’s care that a parent could do, other than the acts reserved in Section 4.
4. Powers Reserved to the Parent
The Parent keeps every parental right not delegated here. Without the Parent’s written consent in each case, the Guardian may not: consent to the Child’s marriage or adoption; consent to the withholding or withdrawal of life-sustaining treatment, sterilisation, or participation in research; move the Child’s residence to a different state or outside the United States, or take the Child abroad if Section 3(d) does not allow it; change the Child’s name, religion or nationality; enlist the Child in the armed forces; or sell, encumber or manage any property of the Child other than money received under Section 3(e). The Parent also reserves the following decisions: [Decisions the parent keeps (or “None beyond those listed in Section 4”)].
5. Standard of Care
The Guardian shall care for the Child as a reasonable and prudent parent would, keep the Child safe, ensure regular school attendance, maintain the Child’s medical, dental and vision care, administer any prescribed medication as directed, and support the Child’s relationship with the Parent and with the Child’s siblings and extended family. The Guardian shall not use corporal punishment beyond what the law of the State allows, shall not leave the Child in the care of any person the Parent has asked the Guardian to exclude, and shall notify the Parent at once of any contact from police, child protective services, a court or the other parent concerning the Child.
6. Contact With the Parent
The Parent and the Child shall have contact as follows: [Contact between parent and child]. The Guardian shall facilitate that contact, shall not prevent or discourage it, and shall keep the Parent informed of the Child’s health, schooling, activities and wellbeing. The Parent may visit the Child at reasonable times on reasonable notice and may take the Child for visits with the Guardian’s agreement, which shall not be unreasonably withheld.
7. Financial Support
The Parent shall pay the Guardian [Monthly support paid by parent to guardian] per month toward the Child’s expenses, on day [Paid on this day of each month] of each month during the Period, and shall reimburse the Guardian within fourteen days, on presentation of receipts, for medical, dental, school and other expenses of the Child reasonably incurred and not covered by insurance or by the monthly support. Child support, benefits and other money received for the Child under Section 3(e) shall be applied to the Child’s needs first and credited against the Parent’s obligation. The Guardian is not entitled to compensation for the Guardian’s own time unless the Parties agree in writing.
8. Health and Insurance Information
The Child’s allergies, medications, conditions and physician are: [Child’s allergies, medications, conditions and physician]. The Child is insured under: [Health insurance (carrier and member no.)]. The Guardian may present this information to any provider. The Parent authorises every physician, dentist, hospital, school and agency holding records of the Child to release them to the Guardian and to discuss the Child with the Guardian during the Period, and intends the Guardian to be treated as the Child’s personal representative for that purpose under 45 CFR §164.502(g) to the extent the law allows.
9. Reliance by Third Parties
Any school, physician, hospital, pharmacy, insurer, carrier, agency or other person may rely on this Agreement, or on a photocopy, scan or electronically signed copy of it, as the Parent’s consent to the Guardian acting within the powers delegated, without further inquiry, and the Parent releases any person who does so in good faith from liability for having done so. The Parent agrees to indemnify the Guardian against any claim arising from an act done in good faith and within the scope of this Agreement.
10. Revocation and Early Termination
The Parent may revoke this Agreement at any time by written notice to the Guardian, effective when received, and may resume custody of the Child immediately on revocation; the Guardian shall return the Child and the Child’s belongings and documents without delay. The Guardian may end this Agreement on [Notice to end early (days)] days’ written notice to the Parent, or immediately if the Guardian becomes unable to care for the Child, in which case the Guardian shall keep the Child safe until the Parent or a person the Parent designates in writing collects the Child. This Agreement ends automatically at the end of the Period, on the death of the Parent or the Guardian, or on the order of a court. Revocation or termination does not affect acts done in good faith before notice was received.
11. Governing Law; Entire Agreement; Severability
This Agreement is governed by the laws of the State of [Governing law (state)]. It is the entire agreement between the Parties about the Child’s care during the Period and may be amended only in a writing signed by both. If any provision is held invalid or beyond what the law allows a parent to delegate without court approval, the remaining provisions shall be given full effect. This Agreement may be signed electronically and in counterparts, and the electronic execution record, timestamps and document fingerprints kept by the signing platform are evidence of execution; where the law of the State or a third party requires it, the Parent intends to have the Parent’s signature acknowledged before a notary public on a printed copy, and that copy shall be an original of this Agreement.
12. Signatures
12.1 Parent. I, [Parent: full name], sign this Agreement on the date shown in the execution record and declare that I have legal authority to make this delegation, that no court order prohibits it, and that the statements in this Agreement are true.
12.2 Guardian. I, [Guardian: full name], accept the temporary guardianship of [Child: full name] on the terms of this Agreement. I confirm that I have read the powers, limits and duties above and the Child’s health information, that I will act only within them and in the Child’s best interest, that I will return the Child to the Parent when this Agreement ends or is revoked, and that I understand this Agreement is not a court order. I sign on the date shown in the execution record.
Signatures
Parent or legal guardian · Temporary guardian