Standby Guardian Designation

STANDBY GUARDIAN DESIGNATION

(District of Columbia – D.C. Code § 16-4801 et seq.)

This Standby Guardian Designation (“Designation”) is made on [DATE] by [PARENT/GUARDIAN FULL LEGAL NAME] (“Designating Parent”), residing at [ADDRESS].

1. MINOR CHILD(REN)

• Child Name: [CHILD FULL LEGAL NAME], Date of Birth: [DOB]
• Child Name: [CHILD FULL LEGAL NAME], Date of Birth: [DOB]

2. DESIGNATED STANDBY GUARDIAN

I designate the following individual as Standby Guardian for the minor child(ren):

• [STANDBY GUARDIAN NAME]
• Relationship to child(ren): [RELATIONSHIP]
• Address: [ADDRESS]
• Phone/Email: [CONTACT INFO]

3. ALTERNATE STANDBY GUARDIAN

If the primary standby guardian is unable or unwilling to serve, I designate:

• [ALTERNATE STANDBY GUARDIAN NAME]
• Relationship to child(ren): [RELATIONSHIP]
• Address: [ADDRESS]
• Phone/Email: [CONTACT INFO]

4. TRIGGERING EVENT

This Designation becomes effective upon:

☐ My incapacity as determined by [PHYSICIAN/COURT/OTHER]
☐ My death
☐ Other: [OTHER TRIGGER]

5. AUTHORITY GRANTED

I authorize the standby guardian to act in the best interests of the child(ren), including decisions regarding:

☐ Education
☐ Medical care
☐ Housing and daily care
☐ Travel
☐ Other: [OTHER AUTHORITY]

6. SPECIAL INSTRUCTIONS

☐ School preference: [SCHOOL]
☐ Medical providers: [PROVIDERS]
☐ Religious/cultural preferences: [PREFERENCES]
☐ Contact with non-custodial parent: [CONTACT PLAN]
☐ Other instructions: [OTHER]

7. REVOCATION

I revoke all prior standby guardian designations for the minor child(ren) listed above.

8. SIGNATURES

Designating Parent Signature: ________________________________ Date: ____________

Printed Name: [PARENT/GUARDIAN FULL LEGAL NAME]

9. WITNESSES

Witness 1 Signature: ________________________________ Date: ____________
Printed Name: [WITNESS 1 NAME]

Witness 2 Signature: ________________________________ Date: ____________
Printed Name: [WITNESS 2 NAME]

10. NOTARY ACKNOWLEDGMENT

District of Columbia )
City of [CITY] )

On this ___ day of ____________, 20__, before me, the undersigned notary public, personally appeared [PARENT/GUARDIAN FULL LEGAL NAME], who acknowledged execution of this instrument.

Notary Public: ________________________________

My Commission Expires: _________________________