APPOINTMENT OF SHORT-TERM GUARDIAN

755 ILCS 5/11-5.4

It is important to read the following instructions:

By properly completing this form, a parent or the guardian of the person of the child is appointing a guardian of a child of the parent (or a minor ward of the guardian, as the case may be) for a period of up to 365 days. A separate form should be completed for each child. The person appointed as the guardian must sign the form, but need not do so at the same time as the parent or parents.

If you are a parent or guardian who is a member of the Armed Forces of the United States, including any reserve component thereof, or the commissioned corps of the National Oceanic and Atmospheric Administration or the Public Health Service of the United States Department of Health and Human Services detailed by proper authority for duty with the Armed Forces of the United States, or who is required to enter or serve in the active military service of the United States under a call or order of the President of the United States or to serve on State active duty, you may appoint a short-term guardian for your child for the period of your active duty service plus 30 days. When executing this form, include the date your active duty service is scheduled to begin in part 3 and the date your active duty service is scheduled to end in part 4.

This form may not be used to appoint a guardian if there is a guardian already appointed for the child, except that if a guardian of the person of the child has been appointed, that guardian may use this form to appoint a short-term guardian. Both living parents of a child may together appoint a guardian of the child, or the guardian of the person of the child may appoint a guardian of the child, for a period of up to 365 days through the use of this form. If the short-term guardian is appointed by both living parents of the child, the parents need not sign the form at the same time.

Parent (or guardian) and Child. I, , currently residing at , , ______________________________________________, am a parent (or the guardian of the person) of the following child (or of a child likely to be born): .

2. Guardian. I hereby appoint the following person as the short-term guardian for my child: (include name and address)

3. Effective date. This appointment becomes effective: (Check one if you wish it to be applicable)

• On the date that I date in writing that I am no longer either willing or able to make and carry out day- to-day child care decisions concerning the child.
• On the date that a physician familiar with my condition certifies in writing that I am no longer willing or able to make and carry out day- to day child care decisions concerning the child.
• On the date that I am admitted as an in-patient to a hospital or other health care institution.
• On the following date: _________________________________________
• On the date my active duty service begins: _________________________________________
• Other: _________________________________________

(Note: If this item is not completed, the appointment is effective immediately upon the date the form is signed and dated below.)

4. Termination. This appointment shall terminate 365 days after the effective date, unless it terminates sooner as determined by the event or date I have indicated below: (check one if you wish it to be applicable).

• On the date that I state in writing that I am willing and able to make and carry out day-to-day child care decisions concerning the child, but not more than 365 days after the effective date.
• On the date that a physician familiar with my condition certifies in writing that I am willing and able to make and carry out day-to–day child care decisions concerning the child, but not more than 365 days after the effective date.
• On the date that I am discharged from the hospital or other health care institution where I was admitted as an in-patient, which established the effective date, but not more than 365 days after the effective date.

•                         On the date which is _________________________________________  days after the effective date. (may
                                               not exceed 365 days). 
                     

• 
                      On the date no more than 30 days after my active duty service is scheduled to end
                          (insert date active duty service is scheduled to end):
   _____________________________________________
                      

• Other: ____________________________________________________________________________

(Note: If this item is not completed, the appointment will be effective for a period of 365 days, beginning on the effective date.)

5. Date and signature of appointing parent or guardian.

This appointment is made this day of , 20.

     Signed:_______________________ (appointing parent or guardian)

6. Witnesses. I saw the parent (or the guardian of the person of the child) sign this instrument or I saw the parent (or the guardian of the person of the child) direct someone to sign this instrument for the parent (or the guardian). Then I signed this instrument as a witness in the presence of the parent (or the guardian). I am not appointed in this instrument to act as the short-term guardian for the parent’s child.

                                Witness___________________________________________________________________________
                                (Signature)
                                __________________________________________________________________________________
                                 (Name)
                                 _________________________________________________________________________________
                                 (Address)
                            
 



                            
                                Witness_____________________________________________________________________________
                                (Signature)
                                ____________________________________________________________________________________
                                 (Name)
                                 ___________________________________________________________________________________
                                 (Address)
                            
                            
7. Acceptance of short-term guardian.
                            

                                

                                    I accept this appointment as short-term guardian on this ________________________________  day of __________________ , 20___________.

                                
                            

                                
signed __________________________________________________________________________________
                                   

                                    
 (Short-term guardian) 
                                    

                                    

                                        8. Consent of child’s other parent. I,     , 

                                        currently residing at 
                                        ,
                                        hereby consent to this appointment on this _________________ day of ________________,20 ___________,
                                    

                                    
signed _________________________________________
                                        
                                                        (Consenting parent)  
                                     

                                        
(Note: the signature of a consenting parent is not necessary if one of the following applies: (i) the
                                            child’s other parent has died: or (ii) the whereabouts of the child’s other parent are not known; or
                                            (iii) the child’s other parent is not willing or able to make and carry out day-to-day child care
                                            decisions concerning the child; or (iv) the child’s parents were never married and no court order
                                            has issued an order establishing parentage.) 
                                            
(Source: P.A. 95-568, eff. 6-1-08)
                                            
755 ILCS 5/11 - 13.2 Duties of a short term guardian of a minor. 
                                            
(a) Immediately upon the effective date of the appointment of a short-term guardian, the short term guardian of the minor shall assume all duties as short-term guardian of the minor as
                                                provided in this Section. The short-term guardian of the person shall have authority to act as
                                                short-term guardian, without direction of court, for the duration of the appointment, which in no
                                                case shall exceed a period of 365 days. The authority of the short-term guardian may be limited
                                                or terminated by a court of competent jurisdiction. 
                                                    

                                                        (b) Unless further specifically limited by the short-term guardian, a short-term guardian shall
have the authority to act as guardian of the person of a minor as prescribed in Section 11-13, but
shall not have any authority to act as guardian of the estate of a minor, except that a short-term
guardian shall have the authority to apply for and receive on behalf of the minor benefits to
which the child may be entitled from or under federal, State, or local organizations or programs.