Illinois Appointment of Short-Term Guardian of a Minor

APPOINTMENT OF SHORT-TERM GUARDIAN OF A MINOR

Illinois · 755 ILCS 5/11-5.4

1. Appointing Parent or Guardian and Child

I, [APPOINTING ADULT'S FULL LEGAL NAME], of [ADDRESS], am the child's ☐ parent ☐ adoptive parent ☐ adjudicated parent ☐ court-appointed guardian of the person. If I am a parent, my parental rights have not been terminated. If I am a court-appointed guardian, I identify my appointment as [COURT, CASE NUMBER, AND DATE].

I appoint a short-term guardian for this unmarried minor child:

Child's full legal name: [________________________________]

Child's date of birth: [__/__/____]

Child's current address: [________________________________]

2. Appointment and Scope

I appoint [SHORT-TERM GUARDIAN'S FULL LEGAL NAME], of [ADDRESS], telephone [PHONE], as the child's short-term guardian of the person under 755 ILCS 5/11-5.4. The appointee may carry out the care and education duties of a guardian of the person under §§ 11-13 and 11-13.2, subject to the limits written below and applicable law.

Specific limits, if any: [________________________________]

This appointment does not grant guardianship of the child's estate. It does not terminate either parent's rights or substitute for a court order appointing a guardian. The short-term guardian may apply for and receive benefits on the child's behalf as § 11-13.2(b) permits.

3. Effective Date and End of Appointment

This appointment takes effect ☐ when I sign it ☐ on [__/__/____] ☐ when the following event occurs: [EVENT]. Record the actual effective date when known: [__/__/____].

It ends ☐ 365 days after its effective date ☐ on the earlier date [__/__/____] ☐ when the following earlier event occurs: [EVENT]. An ordinary appointment under § 11-5.4(c) cannot continue beyond 365 days from its effective date. Any special active-duty or administrative-separation extension requires a separate review of § 11-5.4(d-5) or (e-10).

I confirm that no other written short-term guardian appointment for this child will be in force at the same time. I may amend or revoke this appointment by communicating the change to the short-term guardian or another person under § 11-5.4(d).

4. Other Parent's Consent

Other parent's name: [________________________________]

Select one:

☐ The other living parent, adoptive parent, or adjudicated parent has known whereabouts, has parental rights that have not been terminated, and is willing and able to make and carry out day-to-day child-care decisions. That parent consents by signing Section 7.

☐ The other parent's signature is not required because: ☐ there is no other living parent with intact parental rights ☐ the other parent's whereabouts are unknown ☐ the other parent is unwilling or unable to make and carry out day-to-day child-care decisions. Relevant facts: [________________________________].

The other parent's rights remain unaffected by this appointment.

5. Appointing Adult's Signature

I make this appointment voluntarily and identify the child and appointee above. I sign in the presence of the two adult witnesses below.

Date signed: [__/__/____]

Signature: [________________________________]

Printed name: [________________________________]

6. Two Adult Witnesses

Each witness confirms that the appointing adult signed, or directed another person to sign, this instrument in the witness's presence; each witness is at least 18 years old, credible, and is not the person appointed as short-term guardian.

7. Other Parent's Consent, When Required

I consent to the appointment above as the child's other parent. My signature does not end my parental rights.

Signature: [________________________________] Printed name: [________________________________] Date: [__/__/____]

8. Appointee's Acceptance

I accept appointment as short-term guardian of the person of the named child. My signature may be made after the appointing adult signs.

Signature: [________________________________] Printed name: [________________________________] Date: [__/__/____]

Source: Illinois Probate Act §§ 11-5.4, 11-13.2, and 11-13.