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China Temporary Child Guardianship Agreement

The following Temporary Guardianship Authorization for Care of Minor agreement is written by our China divorce lawyer. Should you know more about China divorce law and Child custody, please contact our China divorce lawyer.

Temporary Guardianship Authorization for Care of Minor

Child Name:              _
Permanent address:                        
Phone:               
Birthdate:              _

Child's School or Day Care
[Leave this section blank if your child is not in school or any type of child care program.]
School or child care program:              _ Grade (if in school):  _
Teacher:               _
School address:                            
Phone:                _
Other child care program (such as after-school program):            
Address:                               
Phone:                _
Responsible adult:           

Child's Doctor, Dentist, and Insurance
Doctor (or HMO):           
Address:                             
Phone:                
Name of medical insurer/health plan:            _
Policy no.:               _
Dentist:                _
Address:                          _
Phone:                
Name of dental insurer/dental plan:             _
Policy no.:               _

Parents (or Legal Guardians)
Parent 1
Name:                 _
Address:                                
Home phone:               _    Work phone:          _
Cell phone or pager:            _    Email:            

Parent 2
Name:                 _
Address:                               
Home phone:               _    Work phone:          _
Cell phone or pager:            _    Email:            

Temporary Guardian
Name:                 _
Address:                               _
Home phone:               _    Work phone:          _
Cell phone or pager:            _    Email:            
Relationship to minor:                           _

Emergency Contact
In case of emergency, if the guardian cannot be reached, please contact:         
Home phone:               _    Work phone:          _
Cell phone or pager:            _    Email:            

Authorization and Consent of Parent(s) or Legal Guardian(s)
[If there is more than one parent, the use of the singular incorporates the plural.]
1.I affirm that I have legal custody of the minor child named above, who is my child.
2.I give my full authorization and consent for my child to live with and travel with the temporary guardian, and for the temporary guardian to establish a place of residence for my child.
3.I give the temporary guardian permission to act in my place and make decisions pertaining to my child's educational, recreational, and religious activities.
4.I give the temporary guardian permission to authorize medical and dental care for my child, including but not limited to medical examinations, X-rays, tests, anesthesia, surgical operations, hospital care, or other treatments that, in the temporary guardian's sole opinion, are needed or useful for my child. Such medical treatment shall be provided only upon the advice of and supervised by a physician, surgeon, dentist, or other medical practitioner licensed to practice in the United provinces.
5.This authorization shall cover the period from         to        _.
6.While the temporary guardian cares for my child, the costs of my child's upkeep, living expenses, and medical and dental expenses shall be paid as follows:                                   .
I declare under penalty of perjury under the laws of the province of        _ that the foregoing is true and correct.
Parent 1's signature:            
Date:                  

Parent 2's signature:            
Date:                  

Consent of Temporary Guardian
I solemnly affirm that I will assume full responsibility for the minor who will live with me during the period designated above. I agree to make necessary decisions and to provide consent for the minor as set forth in the above Authorization and Consent of Parent(s). I also agree to the terms of the costs of the minor's upkeep, living expenses, and medical and dental expenses as set forth in the above Authorization and Consent of Parent(s).
I declare under penalty of perjury under the laws of the province of        _ that the foregoing is true and correct.
Temporary guardian's signature:                       _
Date:                  

 

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