_________________

Date

TEMPORARY GUARDIAN FORM

I ________________________________(name of parent of minor)do hereby give permission for __________________________________(adult assigned guardianship of minor)  to act as temporary guardian for my son/daughter. I have provided ______________________(adult assigned guardianship of minor) with an AUTHORIZATION FOR THIRD PARTY TO CONSENT TO TREATMENT OF MINOR LACKING CAPACITY TO CONSENT form, as well as the 1^st Louisiana Contract Regarding Alcohol and Drug Use. My child____________________________________________age:____________________will be under the direct supervision of ______________________________________(adult assigned guardianship of minor) and____________________ I give permission for _________________________(adult assigned guardianship of minor) to sign any and all American Civil War registration forms or other pertinent forms relating to the American Civil War Society for the weekend of _____________________to________________________, event entitled________________________________________.

Parent/Guardian: (please print clearly)_____________________________________

Contact number:______________________________

Additional contact number:_______________________________

I ____________________________ (adult assigned guardianship) to agree to take full responsibility for ____________________________________________________(minors name)  for the above stated event and dates.

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