Form Section 1

Guardianship Letter

A member of our staff will contact you to go over the information you are about to provide us. 

We have provided a blank area for comments at the very end.

1. Information about the Customer

Your Name:
Your Address:

2. Information about the Minor Child(ren)

Minor Child # 1

Name of Child #1:
Date of Birth:
Age and Year in school

Minor Child # 2

Name of Child #1:
Date of Birth:
Age and Year in school

Minor Child # 3

Name of Child #3:
Date of Birth:
Age and Year in school

Minor Child # 4

Name of Child #4:
Date of Birth:
Age and Year in school
Form Section 2

3. Information about the Mother

Mother's Name:
Mother's Address:
Mother's Phone numbers

4. Information about the Father

Father's Name:
Father's Address:
Father's Phone numbers
Form Section 3

5. Information about the Proposed Guardian

Proposed Guardian's Name:
Proposed Guardian's Address:
Proposed Guardian's Phone numbers

6. Emergency Contact

In case of emergency, if the proposed guardian cannot be reached, please contact...

Name of Emergency Contact:
Name of Individual who will pay Medical Costs:

7. Length of Authorization

Authorization Start Date
Authorization End Date
State and Country where the notarization will take place
Form Section 4

Contact Info, Comments

Name of the person filling out the questionnaire
All answers were provided by me and I did not receive any legal advice from the staff at The Document People