Temporary Guardianship Authorization For Care of Minor: Child
Temporary Guardianship Authorization For Care of Minor: Child
Temporary Guardianship Authorization For Care of Minor: Child
Child
Name: ____________________________________________________________________________________
Permanent address: ________________________________________________________________________
Phone: ______________________________________ Birthdate: ____________________________________
Dentist: ___________________________________________________________________________________
Address: __________________________________________________________________________________
_____________________________________________ Phone: _______________________________________
Name of dental insurer/dental plan: __________________________________________________________
Policy number: ______________________________ Phone: _______________________________________
Parent 2
Name: ____________________________________________________________________________________
Address: __________________________________________________________________________________
www.nolo.com Form 1
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________________________________________________________________________________
Home phone: ______________________________________________________________________________
Work phone: ______________________________________________________________________________
Cell phone: __________________________________ Email: _______________________________________
Temporary Guardian
Name: ____________________________________________________________________________________
Address: __________________________________________________________________________________
________________________________________________________________________________
Home phone: ______________________________________________________________________________
Work phone: ______________________________________________________________________________
Cell phone: __________________________________ Email: _______________________________________
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Date ______________________________________________________________________________________
www.nolo.com Form 1
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