Temporary Guardianship Form

Student's First Name *

Student's Surname *

Date of Birth: *

Nationality: *

Gender: *

Male

Female

Other

Student's Mobile Number: *

Are there any Medical conditions or allergies that we need to be aware of? *

Yes

No

If yes, please provide details:

Are there any allergies for example to medication, food or animals we need to be aware of? *

Yes

No

If yes, please provide details:

Are there any food intolerances or dietary requirements we need to be aware of? *

Yes

No

If yes, please provide details:

School: *

Name of Parent/Guardian: *

Email Address: *

Contact telephone numbers of parent/guardian during period of temporary guardianship:

Mobile Number: *

Home Number: *

Dates of Temporary Guardianship: *

I request Guardians UK to act as my representative in undertaking the temporary guardianship of this student during the above period. It is agreed that:

The student accepts the responsibility of Guardians UK and the host family to act in their best interests with regard to welfare and to follow the host family house rules.
The parents/guardian bestows upon Guardians UK the legal right to exercise parental responsibility in any situation, particularly in emergencies and where an urgent decision is required (e.g consent to carry out medical treatment), if the parents/guardian cannot be contacted.
The parents/guardian accepts that the student may be discharged from the care of the host family should his/her behaviour become unacceptable. In such circumstances the parents/guardian would be contacted and asked to make arrangements for the student be collected from the host family.

Signed: *

Date Signed: *

Once the agreement has been recieved we will raise an invoice which is payable in full before the arrangement commences unless prior arrangements have been agreed.