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PARENTAL DESIGNATION AND CONSENT TO THE BEGINNING OF
STANDBY GUARDIANSHIP
AHA ỌZIZA ONYE NNE NA NNA NA INYE NKWEKỌRỊTA NA MBIDO NKE
ONYE NLEKOTA NKE KWỤNANCHERE
(Estates and Trusts § 13-904)
(Ala na ulo na njide akunuba onye ozo 13-904)
NOTE: Use this form to designate an adult to be standby guardian of your minor child(ren) if you become
mentally incapacitated, physically debilitated, or subject to an adverse immigration action.
OZI EDEREDE: Were akwukwo a họrọ otu onye okenye ga abu onye nlekota nke kwụnanchere nwata(umuaka)
gi ọ bụrụ na ị nweghị uche, anaghị emegharı ahụ, maọbụ nọrọ na ọnọdụ ime ihe mbiara mbiara di njo.
Mentally incapacitated: Your attending physician determines you have a mental impairment that
causes a chronic and substantial inability to understand the nature and consequences of decisions
about the care of your child(ren). Because of the incapacity, you cannot care for your child(ren).
Enweghi uche Onye dokita na eledo gi anya ga ekpebi na inwere nsogbu uche na ebute ogologo oria
na enweghi ike ighota udi na nsonazu mkpebi banyere nlekota nwa(umu) gi di mkpa. N’ihi enweghi
ike, I gaghi elekotanwu nwa(umu) gi.
Physically debilitated: Your attending physician determines you have a physically incapacitating
illness, disease, or injury that causes a chronic and substantial inability to care for your child(ren).
Anaghị emegharị ahụ Onye dokita na eledo gi anya ga ekpebi na I nwere oria onodu anuahu, oria,
maobu mmeru ahu na ebute ịnọ na ọrịa ogologo oge na enweghi ike ilekotanwu nwa(umu) gi di mkpa.
Subject to an adverse immigration action: You are arrested or apprehended by law enforcement for
an alleged violation of federal immigration law; detained by or in the custody of the Department of
Homeland Security (DHS) or a federal, state, or local agency authorized by or acting on behalf of DHS;
must leave the United States under an order of removal, deportation, exclusion, voluntary departure,
expedited removal, or a stipulation of voluntary departure; subject to the denial, revocation, or delay of
the issuance of a visa or transportation letter by the Department of State; subject to the denial, revocation,
or delay of the issuance of a parole document or reentry permit by DHS; or denied admission or entry
into the United States by DHS.
Ino na onodu ime ihe mbiara mbiara di njo: Ejidere gi maobu ijide gi site na ndi mbanye iwu maka
ebubo imebi iwu nke goomenti etiti maka ndi mbiara mbiara; ejidere site na maobu na nlekota nke
Department of Homeland Security (DHS) maobu goomenti etiti, steeti, ulo oru ebe obodo enyere ikike
site na maobu na aru oru na nnochiteanya nke DHS; ga ahapu riri obodo United Steeti n’okpuru iwu
mwepu, mbula, mwepu, ipu na obioma; ikwalite mwepu maobu nkwete ipu n’obioma; idebe na onodu
ekweghi ekwe, nkagbu, maobu igbu oge inye visa maobu leta njem site na Ngalaba nke Steeti; idebe na
onodu ekweghi ekwe, nkagbu, maobu igbu oge na inye akwukwo mpoputa onye mkporo nke nwa oge
maobu ikike ibanyechi ozo site na DHS; maobu nnabata ana ekweghi maobu mbata na obodo United
Steeti site na DHS.
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Designation of Standby Guardian
Aha ozịza Onye Nlekota nke kwụnanchere
I/We, _____________________________________________________________________________________,
Your Name(s)
designate __________________________________________________________________________________,
(Name of Standby Guardian)
whose address is ___________________________________________________, whose telephone number is
_________________________ and whose email address (if available) is _______________________________,
as standby guardian of the person property person and property of my/our minor child(ren):
M/Anyi, __________________________________________________________________________________ ,
Aha gi
họrọ _____________________________________________________________________________________ ,
Aha Onye Nlekota nke kwụnanchere
onye adressi ya bu ___________________________________________________,onye akara ekwenti ya bu
_______________ na onye ozi intaneeti ya (ma oburu na odi) bu __________________, dika onye nlekota nke
kwụnanchere nke akunuba mmadu mmadu na akunuba nkem/nwata(umuaka) anyi na abughi okenye n’iwu:
Name of Child(ren) Date of Birth
Aha Nwata(umuaka) Ubochi Omumu
Alternate Standby Guardian
Onye Nnochianya Onye Nkelota nke kwụnanchere
Complete this section if you want to name another person to serve as standby guardian if the person named
above is unable or unwilling to act as standby guardian of your minor child(ren).
Mezuo nkebi a ma oburu na I choro ide aha onye ozo ga aru oru onye nlekota nke kwụnanchere ma oburu
na onye edere aha ya n’elu enweghi ike maobu achoghi iru oru dika onye nlekota nke kwụnanchere nke
nwata(umuaka) gi n’abughi okenye n’iwu.
If the person I/we designate above is unable or unwilling to act as standby guardian for the child(ren), I/we
designate __________________________________________________________________ , whose address is
Name of Alternate Standby Guardian
_____________________________________________, whose telephone number is _____________________
and whose email address (if available) is ___________________________________ , as standby guardian of the
person property person and property of my/our minor child(ren):
O buru na onye ahu Mu/anyi dere aha ya n’elu enweghi ike maobu achoghi iru oru dika onye nlekota nke
kwụnanchere maka nwata(umuaka), M/anyi dere aha ____________________________________________ ,
Aha Onye Nnochianya Onye Nlekota nke kwụnanchere
onye adressi ya bu _____________________________________ , onye akara ekwenti ya bu ______________
ma onye ozi intaneeti ya (ma oburu na odi) bu __________________________ , dika onye nlekota nke kwụnanchere
nke akunuba mmadu mmadu na akunuba nkem/nwata(umuaka)anyi na abughi okenye n’iwu:
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Other Parties with Parental Rights
Ndi ozo nwere Ikike Nne na Nna
Complete this section if another person (or persons) has parental rights to the minor child(ren)
(e.g., a biological parent or legal guardian).
Mezuo nkebi a ma ọ bụrụ na onye ozo (maọbụ ọtụtụ mmadụ) nwere ikike nne na nna n’ebe nwata(umuaka)
na abughi okenye n’iwu (omumatu; nne na nna muru ya maobu onye nlekota n’iwu).
The following other person(s) has parental rights to the minor child(ren):
Ndi ozo na esote nwere ikike nne na nna n’ebe nwata(umuaka) ahu:
Name of person with parental rights:
Aha onye nwere ikike nne na nna:
Relationship to minor child(ren):
(select one):
Mmekorita ya na nwata(umuaka) na abughi okenye n’iwu:
(horo otu):
He/She consents to this designation of standby guardian below. (See Consent to Designation
of Standby Guardian on page 5 of this form).
Ya/O kwenyere na aha ozịza a nke onye nlekota nke kwụnanchere di n’okpuru. (Lee Nkwenye
na Aha nke Onye Nlekota Di N’njikere na peeji ise nke akwukwo a).
He/She has not consented to the designation of standby guardian because he/she (check all
that apply):
Ya/O ekwenyeghi na aha onye nlekota di n’njikere maka na ya/o (Kanye ndi niile dabara) :
is mentally or physically unable to give consent
enweghi ike inye nkwenye n’uche maọbụ na anuahu
abandoned the child
gbahapuru nwata ahu
no longer has legal custody of the child
enweghizi nlekota nwata ahu n’iwu
lives in another country
bi na mba ozo
parentage unknown
amaghi nne na nna onye ahu
cannot be located and the following efforts have been made to locate him/her:
achọtaghị ya ma agbala mbo ndi a iji chota ya/ya:
Name of person with parental rights:
Aha onye nwere ikike nne na nna:
Relationship to minor child(ren):
(select one):
Mmekorita ya na nwata(umuaka) na abughi okenye n’iwu:
(horo otu):
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He/She consents to this designation of standby guardian below. (See Consent to Designation
of Standby Guardian on page 5 of this form).
Ya/O kwenyere na aha ozịza a nke onye nlekota nke kwụnanchere di n’okpuru. (Lee Nkwenye
na Aha ọzịza nke Onye Nlekota nke kwụnanchere na peeji ise nke akwukwo a).
He/She has not consented to the designation of standby guardian because he/she (check all
that apply):
Ya/O ekwenyeghi na aha ozịza onye nlekota nke kwụnanchere maka na ya/o (kanye ndi
niile dabara):
is mentally or physically unable to give consent
enweghi ike inye nkwenye n’uche maọbụ na anuahu
abandoned the child
gbahapuru nwata ahu
no longer has legal custody of the child
enweghizi nlekota nwata ahu n’iwu
lives in another country
bi na obodo ozo
parentage unknown
amaghi nne na nna onye ahu
cannot be located and the following efforts have been made to locate him/her:
achọtaghị ya ma agbala mbo ndi a iji chota ya/ya:
Consent to the Beginning of the Standby Guardianship
Nkwenye na mbido nke Onye Nlekota nke kwụnanchere
I/We consent to the beginning of the standby guardianship when (select all that apply):
M/Anyi kwenyere na mbido nke onye nlekota nke kwụnanchere mgbe (horo ndi niile dabara):
the standby guardian receives a determination that I am/we are mentally incapacitated (definition
on page 1) from my/our attending physician.
onye nlekota nke kwụnanchere nwetara mkpebi na abu m/anyi bu onye enweghị uche (nkowa ya
no na peeji nke mbu) site na onye dokita na eledo mu/anyi anyi.
the standby guardian receives a determination that I am/we are physically debilitated (definition
on page 1) from my/our attending physician and a copy of the birth certificate for each minor child.
onye nlekota di n’njikere nwetara mkpebi na abu m/any bu onye adighi ike nke onuahu(nkowa
ya no na peeji nke otu) site na onye dokita na eledo mu/anyi anya na otu akwukwo nke omumu nwa
maka otu nwata obula na abughi okenye n’iwu.
the standby guardian receives evidence that I am/we are subject to an adverse immigration
action (definition on page 1).
onye nlekota nke kwụnanchere nwetara ihe akaebe na abu m/anyi bundi nọ na onodu ime ihe
mbiara mbiara di njo (nkowa ya no na peeji nke mbu).
Powers and Duties of Standby Guardian of Person
Ike na Oru Onye nlekota nke kwụnanchere nke mmadu
Complete this section if you want the standby guardian to act as the minor child(ren)’s guardian of
the person. A guardian of the person makes non-financial decisions (e.g., housing, medical care, education,
clothing, food, and everyday needs).
Mezuo nkebi a ma ọ bụrụ na i choro ka onye nlekota nke kwụnanchere ruo oru dika onye nlekota
mmadu nwata(umuaka) ahu. Onye nlekota mmadu ahu na eme mkpebi na abughi ego (omumatu;
ulo ebe obibi, nlekota ahuike, agumakwukwo, akwa, nri, na mkpa kwa ubochi).
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I/We grant the standby guardian of the person the authority to (check all that apply):
M/Anyi na enye onye nlekota nke kwụnanchere mmadu ahu ikike iji (kanye nke dabara)):
provide for the child(ren)’s physical and mental well-being, including, providing food
and shelter.
Nweta odi mma ezi uche na anuahu nwata(umuaka) ahu gunyere, enwetara nri na ebe obibi.
make educational decisions and take educational actions on behalf of the child(ren),
including enrolling the child(ren) in school, picking them up from school, making special
education decisions, and obtaining educational records.
mee mkpebi agumakwukwo ma mee ihe agumakwukwo na nnochiteanya nwata(umuaka),
gunyere itinye aha nwata(umuaka) na ulo akwukwo, ikporo ha na ulo akwukwo, ime
mkpebi puru iche maka agumakwukwo ha, na ịnweta ndeko agumakwukwo.
make medical treatment decisions for the child(ren), including determining and consenting
to medical, psychological, and dental treatment, obtaining information and medical and
hospital records, authorizing hospital admissions and discharges, and consulting with health
care providers.
mee mkpebi nlekota ahuike maka nwata(umuaka), gunyere ikpebi na inye ikike na igwo
oria, agwa na uche mmadu, na igwo oria eze, enweta ndeko ozi ogwu na ulo ogwu, inye
ikike iburu beedi na ihapu ulo ogwu, na inata ndumodu puru iche site na ndi na enweta
nlekota ahuike.
make domestic and international travel arrangements for the child(ren), accompany the child(ren)
on trips, and make related arrangements including hotel and other accommodations.
ime nhazi njem nke ebe ulo na mba ozo maka nwata(umuaka) ahu, isonye nwata(umuaka)
aga njem, ma mee nhazi metutara gunyere ulo oriri na nkwari na ulo ndina.
receive and use public benefits and child support payable on behalf of the minor child(ren).
Nata ma jiri uru ọhaneze na nkwado ugwo aga akwu nwata na nnochianya nwata(umuaka).
take any other action required for the child(ren) as I/we might or could take in the best
interest of the child(ren).
mee ihe ndi ozo obula achoro maka nwata(umuaka) ahu dika M/anyi nwere ike maobu ga
eme na mmasi kacha mma nke nwata(umuaka).
Special instructions or limitations (if any):
Ntuziaka puru iche maọbụ mgbochi (ma ọ bụrụ na enwere):
Powers and Duties of Standby Guardian of the Property
Ike na Oru Onye Nlekota nke kwụnanchere nke Akunuba
Complete this section if you want the standby guardian to act as the minor child(ren)’s guardian of
the property. A guardian of the property makes financial decisions (e.g., paying bills or costs to cover
the child(ren)’s personal needs, applying for benefits, paying taxes).
mezuo nkebi a ma ọ bụrụ na i choro ka onye nlekota nke kwụnanchere rụọ oru dika onye nlekota nke
akunuba nwata(umuaka) ahu. Onye nlekota nke akunuba na eme mkpebi ego (omumatu; ịkwụ ụgwọ
maọbụ ụgwọ ga emezu mkpa onwe nwata(umuaka) ahu niile, etinye akwukwo uru, ịkwụ ụgwọ utu).
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I/We grant the standby guardian of the property the authority to (check all that apply):
M/Anyi na enye onye nlekota nke kwụnanchere mmadu ahu ikike iji (kanye nke dabara):
apply funds from the guardianship estate needed for the minor child(ren)’s clothing,
support, care, protection, welfare, and education.
etinye ego site na onye nlekota ala na ulo achoro maka agwa nwata(umuaka) ahu na abughi
okenye n’iwu, nkwado, nlekota, nchekwa, odimma, na agumakwukwo.
apply for public benefits and child support payable on behalf of the minor child(ren).
tinye akwukwo maka uru ọhaneze na nkwado ịkwụ ụgwọ nwata na nnochianya nwata(umuaka)
na abughi okenye n’iwu.
Special instructions or limitations (if any):
Ntuziaka puru iche maọbụ mgbochi (ma ọ bụrụ na enwere):
The following is all property in which the minor child(ren) has interest including an absolute interest, a joint
interest, or an interest less than absolute (attach additional sheets if needed).
Ndi na esonu bu akunuba niile nke nwata(umuaka) nwere mmasi gunyere mmasi zuru ezu, mmasi ejikoro onu,
maọbụ mmasi nke pekariri nke zuru ezu (tinye mpempe akwukwo ozo ma ọ bụrụ na-achoro).
Property
Akunuba
Location
Ebe
Value
Ego uru
Sole owner, joint owner (specific type),
life tenant, trustee, custodian agent, etc.
Nke otu onye nwe, nke agbakotara onu nwere
(kwuputa udi obu), onye bi na ulo ruo ebighi ebi,
onye njikwa akunuba onye ozo, onye nnochianya
onye nlekota, dere gawazia.
Termination and Revocation of Standby Guardianship
Nkwusi na Nkagbu Onye Nlekota nke kwụnanchere
I/We understand that the standby guardian’s authority will end after 180 days unless by that date the
standby guardian petitions the court for appointment as guardian.
M/Anyi ghotara na ikike onye nlekota nke kwụnanchere ga akwusi mgbe otu narị ụbọchị na iri asatọ gachara
ma ewezuga na site ubochi ahu onye nlekota nke kwụnanchere rioro uloikpe maka nhoputa dika onye nlekota.
I/We also understand that I/we retain full parental rights the standby guardian’s authority, and may
revoke the standby guardianship at any time.
M/Anyi ghotakwara na M/anyi ga ejigide ikike nne na nna zuru ezu nke ikike onye nlekota nke
kwụnanchere, manwere ike ikagbu ikike onye nlekota nke kwụnanchere oge obula.
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Designating Parent’s Signature
Mbinye Aka Aha ọzịza Nne na Nna
Date Parent 1 Signature
Ubochi Mbinye aka nne ma ọ bụ nna nke mbu
Address
Adreesi
City, State, Zip
Obodo mepere emepe, Steeti, Koodu mpaghara
Date Parent 2 Signature (if applicable)
Ubochi Mbinye aka Nne ma ọ bụ Nna nke abuo (ma ọ bụrụ na enwere)
Address
Adreesi
City, State, Zip
Obodo mepere emepe, Steeti, Koodu mpaghara
OR
MAOBU
I, ______________________________________________________ , sign on behalf of and at the direction of
Name
______________________________________________ , who is/are physically unable to sign this designation.
Name of Parent(s)
M, _________________________________________________ , binye aka na nnochianya nke na ntuziaka nke
Aha
________________________________________ , kedu onye/ndi na enweghi ike ibinye aka aha ozịza a n’anuahu.
Aha Nne na nna
Date Signature
Ubochi Mbinye aka
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Witnesses to Designation of Standby Guardian Signatures
Ndi akaebe na mbinye aka aha ndi Onye Nlekota nke kwụnanchere
We declare that the person(s) whose name appears above signed this document in our presence, or was physically
unable to sign and asked another to sign this document, who did so in our presence. We further declare that we are at
least 18 years of age and not the person designated as standby guardian or alternate standby guardian.
Anyi na ekwuputa na onye aha ya putara n’elu binyere aka na akwukwo a n’ihu anyi, maọbụ enweghi ike ibinye
aka n’anuahu were gwa onye ozo ka obinyere ya aka na akwukwo a, onye mere nke ahu n’ihu anyi. Anyi na
ekwuputakwa na anyi erugo ihe dịka afo iri na asato, ma anyi abughikwa onye edere aha ya dika onye nlekota
nke kwụnanchere bu onye nnochianya onye nlekota nke kwụnanchere.
Date Witness 1 Signature
Ubochi Mbinye aka Onye akaebe nke mbu
Address
Adreesi
City, State, Zip
Obodo mepere emepe, Steeti, Koodu mpaghara
Date Witness 2 Signature
Ubochi Mbinye aka Onye akaebe nke abuo
Address
Adreesi
City, State, Zip
Obodo mepere emepe, Steeti, Koodu mpaghara
Standby Guardian Signature(s)
Mbinye aka Onye Nlekota nke kwụnanchere
Date Signature of Standby Guardian
Ubochi Mbinye aka Onye Nlekota nke kwụnanchere
Date Signature of Alternate Standby Guardian (if applicable)
Ubochi Mbinye aka Onye Nnochianya Onye Nlekota nke
kwụnanchere (ma ọ bụrụ na enwere)
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CONSENT TO DESIGNATION OF STANDBY GUARDIAN
NKWENYE NA AHA ỌZỊZA NKE ONYE NLEKOTA NKE KWỤNANCHERE
NOTE: Use this form if your child is the subject of a designation of a standby guardian and you agree
(consent) to the designation.
OZI EDEREDE: Jiri akwukwo a ma ọ bụrụ na nwa gi bu onye emeere ihe nke aha ozịza onye nlekota
nke kwụnanchere ma ọ bụrụ na i kwetara (kwenyere) na aha ozịza ahu.
I, ______________________________________________________________ , agree with the designation by
Your Name
____________________________________________ of ___________________________________________
Name of Parent Making the Designation Name of Standby Guardian
as standby guardian of my minor child(ren), and if necessary _________________________________________
Name of Alternate Standby Guardian (if any)
as alternate standby guardian of my minor child(ren):
M, _____________________________________________________________ , kwetara na aha ozịza site na
Aha gi
__________________________________________ nke ____________________________________________
Aha ndi Nne na nna Na Ede Aha Aha Onye Nlekota nke kwụnanchere
dika onye nlekota nke kwụnanchere nke nwata(umuaka) m na abughi okenye n’iwu, ma oburu na odi mkpa
__________________________________________________________________________________________
ha Onye nnochianya Onye Nlekota nke kwụnanchere (ma ọ bụrụ na enwere)
dika onye nnochianya onye nlekota nke kwụnanchere nwata(umuaka) m na abughi okenye n’iwu:
Name of Child(ren) Date of Birth
Aha Nwata(umuaka) Ubochi Omumu Nwa
I agree also to the terms stated above and understand that I retain full parental rights even after the beginning of the
standby guardian’s authority, and may revoke at any time my consent to the standby guardianship.
Ekwetakwara m na ihe ndị edeputara n’elu na aghota na ejigidere m ikike nne na nna zuru ezu obunadi na mmalite
ikike onye nlekota nke kwụnanchere, na enwere ike ikagbu nkwenye m nke onye nlekota nke kwụnanchere oge obula.
Date Signature
Ubochi Mbinye aka
OR
MAOBU
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I, _______________________________________________________ , sign on behalf of and at the direction of
Name
_________________________________________________ , who is physically unable to sign this designation.
Name of Parent
M, _____________________________________________________ , binye aka na nnochianya na ntuziaka nke
Aha
_______________________________________________ , onye na enweghi ike ibinye aka na aha n’anuahu.
Aha nne na nna
Date Signature
Ubochi Mbinye aka
Witnesses to Consent to Designation of Standby Guardian
Ndi akaebe nkwenye na Aha ozịza nke Onye Nlekota nke kwụnanchere
We declare that the person whose name appears above signed this document in our presence, or was
physically unable to sign and asked another to sign this document, who did so in our presence. We further
declare that we are at least 18 years of age and not the person designated as standby guardian or alternate
standby guardian.
Anyi na ekwuputa na onye aha ya putara n’elu binyere aka na akwukwo a n’ihu anyi, maobu enweghi ike
ibinye aka n’anuahu were gwa onye ozo ka obinyere ya aka na akwukwo a, onye mere nke ahu n’ihu anyi.
Anyi na ekwuputakwa na anyi erugo ihe dịka afo iri na asato, anyi abughi onye edere aha ya dika onye
nlekota nke kwụnanchere maọbụ onye nnochianya onye nlekota nke kwụnanchere.
Date Witness 1 Signature
Ubochi Mbinye aka onye akaebe nke mbu
Address
Adreesi
City, State, Zip
Obodo mepere emepe, Steeti, Koodu mpaghara
Date Witness 2 Signature
Ubochi Mbinye aka onye akaebe nke abuo
Address
Adreesi
City, State, Zip
Obodo mepere emepe, Steeti, Koodu mpaghara