Use this form to choose another person to care for your child when you cannot. For example, if you are detained by Immigration and Customs Enforcement (ICE) or are too sick to care for your child.
The person you choose will be able to talk to your child's school, teachers and doctors. The person you choose will be able to make basic decisions about your children's health care. However, the person you choose will not be able to agree to surgery or other major medical procedures for your child.
This form does not change your rights as a parent in any way and you can cancel it at any time. The person you choose will NOT be required to provide financial support for your child.
The person you choose must agree to take care of your child. It is best for you and the temporary guardian to both sign the form in front of a notary. You can sign and get it notarized now, but write on the form that you want it to start only if a certain event happens, for example if you are arrested by ICE.
When will this go into effect?
This permission can go into effect right away, on a specific date in the future, or if a particular event happens, for example if you are detained by Immigration and Customs Enforcement (ICE). In Question 4 on the form, you can choose when you want the permission to go into effect.
How long is it good for?
If the parent and the temporary guardian sign the form in front of a notary, the permission can last up to 6 months after it goes into effect. You can choose if you want the form to last for 6 months or less in Question 4 on the form.
Can I put any limits on this person's ability to make decisions?
This form only gives authority to make routine decisions regarding the child's healthcare and education. If you want to put other specific limits on what the person can decide about your child's healthcare and schooling, you can do that by crossing out and putting your initials next to any of the items in Question 5 on the form.
What if I have shared custody of my child?
If there is a Court order that requires both parents to agree on education and/or health decisions regarding the child(ren), then both parents must sign the form. If not, only one parent’s signature is required.
Filling out the form
Complete the form linked below to designate a person in parental relationship for your child. You can fill out one form for all your children. Or you can fill out separate forms for each child.
It is best for you and the temporary guardian to both sign the form in front of a notary.
Last Reviewed: May 24, 2017