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Temporary Custody Letter (Free Samples)

Use these sample temporary custody letters as templates for your formal custody letter.
Last updated on September 19th, 2021


​Sample 1 - Temporary Custody Letter
John and Jane Smith
123 North Avenue
Belmont, Virginia 89452

DATE

Jack and Mary Johnson
789 Lyndon Road
Belmont, Virginia 89452

RE: Temporary Guardianship of Child, Samantha Smith

John and Jane Smith give Jack and Mary Johnson temporary custody of their minor daughter, Samantha Smith from DATE to DATE.

​This official temporary custody letter will act as a legal and binding document that will enable them to seek medical treatment on behalf of Samantha and to make any decisions concerning her needs for the specified period. 


John and Jane Smith intend to travel to New York City on business concerning the dates previously stated. Therefore, in their absence they will be unable to oversee the needs of their daughter Samantha or provide her medical treatment should she need it during the specified period of time.

They are therefore entrusting their daughter's care to Jack and Mary Johnson and giving them temporary guardianship to make any important decisions regarding their daughter's care. The address of the hotel the Smith's will be staying at is:


Hilton Regency
787 Spartan Lane
New York, New York 10014
(123) 676-9023

Samantha Smith's doctor is Dr. Deetz located at Dixon Medical Center in Belmont, Virginia. Their phone number is (353) 458-9832. Samantha's dentist is Dr. Vogel at Vogel Dentistry.

​Their office number is (353) 458-7622. You can find a copy of this document at either location. John and Jane Smith can be contacted at anytime on their cell phone at (353) 458-4433.


Sincerely, 

(sign your name here)
John and Jane Smith

​Sample 2 - Temporary Custody Letter
William and Elizabeth Smith
120 Jisco West Rd.
Jackson, Ohio 45640

DATE

Kimberly and Jamie Harr
98745 St. Rt. 149
Rosemount, Ohio 45662

Re:  Temporary Guardianship of Minor Child, Adreauna Smith

From DATE till DATE, William and Elizabeth Smith give temporary custody of their daughter, Adreauna Ford, to Jamie and Kimberly Harr.

​This Temporary Guardianship Letter will serve as a legal and binding document that will allow them to obtain medical treatment and to make any decisions regarding the needs of the child for this period. 


William and Elizabeth will be in Europe on business for the dates listed above. They will not be able to provide medical treatment and see to the needs of their child during these time periods. Trusting in good faith, Jamie and Kimberly Harr, they allow temporary guardianship so they may make decisions regarding their child’ care.  

​The address of the hostel that the Smith’s will be stay in is 7890 Piccadilly Square, London, England. The phone number there is +44 20 8988 8300. Since London is five hours ahead of the United States, consideration must be made when calling. 

The child's medical doctor is Jill Neff at McCarty Lane Pediatrics in Jackson. Their phone number is 740-286-5245. Adreauna's dentist is Dr. Rebo at Rebo Health Professionals , and the phone number is 740-286-0989. A copy of this letter will be on file at both locations. 

Sincerely,

William and Elizabeth Ford

​Sample 3 - Temporary Custody Letter
Parent’s Name
Parent’s Address
City, State, Zip Code

DATE

Guardian’s Name
Guardian’s Address
City, State, Zip Code

RE: Temporary Guardianship of minor child, Name of Child

This letter is a legally binding document that gives Name of Guardian temporary guardianship of Name of Parent or Parent’s son, Name of Child.

​The guardianship will be effective from DATE to DATE. Name of Guardian will be allowed to make any decisions regarding medical treatments or other types of permission required by the child during this period. 

Name of Parents will be in India on business during the time given in this letter and will not be easily available to make decisions if any medical treatment is required for their son. The parents can be reached at Address of Hotel, Phone Number of Hotel or by email at Email Address. 

The child’s doctor is Name of Doctor and her phone number is Phone Number. The child’s dentist is Name of Dentist and his phone number is Phone Number. A copy of this letter will be given to both doctors.
 
Sincerely,

Parent or Parent’s Signature
Printed Name of Parent or Parents
​
​By Andre Bradley
​
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