Guardianship Authorization Letter

Guardianship Authorization

Minor Name:  

Passport Number:

Mother Name:

Tel:

Father Name:

Tel:

Address:

Guardian Name:

Relationship: (Guardianship agency, aunt, family friend)

Date of Birth: 

Tel:

Address:

email: 

1.     In case of emergency, if the guardian cannot be reached, please contact name at telephone number.

2.     I give the guardian permission to act in my place and to make decisions pertaining to my child’s educational activities, including, but not limited to enrollment, permission to participate in activities and consent for medical treatment at school.

3.     I give the guardian permission to authorize medical and dental care for my child

4.     This authorization shall cover the period from date begin to date end (reach age of 18). 

I declare that the foregoing is true and correct. 

Yours faithfully, 

Signature of parent                      Signature of parent 

_____________________           ___________________

Full Name of mother                    Full Name of father

Date:                                            Date: