PARENTAL DESIGNATION OF STANDBY GUARDIAN (Sample Form)

I ___________ hereby designate____________________ of _______________, phone # _________ as standby guardian of the person and property of my child(ren): ____________________.
(Children's Name)

The standby guardian's authority shall take effect if and when either:
(1) My doctor concludes I am mentally incapacitated, and thus unable to care for my child(ren); or
(2) My doctor concludes that I am physically debilitated, and thus unable to care for my child(ren) and I consent in writing, before two witnesses, to the standby guardian's authority taking effect.
If the person I designate above is unable or unwilling to act as guardian formy child(ren), I hereby designate ______________________of ________________________,  _____________________, phone ______________________as standby guardian of my child(ren) :_______________________________.

I also understand that my standby guardian's authority will cease 180 days after beginning unless by that date my standby guardian petitions the court for appointment as guardian.

I understand that I retain full parental rights even after the beginning of the standby guardian's authority, and may revoke the standby guardianship at any time.

Parent's Signature: __________________________________
Address: _________________________________________
Date:_____________________

I declare that the person whose name appears above signed this document in my presence, or was physically unable to sign and asked another to sign this document, who did so in my presence. I further declare that I am at least 18 years old and am not the person designated as standby guardian.

Witness's Signature:____________________________
Address:____________________________________
Date:_______________________________________

Witness's Signature: ___________________________
Address: ___________________________________
Date:______________________________________

Standby Guardian's Signature: ______________________________
Address: _____________________________________________
Date: ________________________________________________

Source: Maryland Legal Assistance Network (MLAN), updated by Maryland State Law Library.       

                                                                                                                                         Last Legal Review 02/04/08 (PLL/M.A.J.)