IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) ) ) ) ) Minor Date of Birth: I swear (or affirm) that the following is true: 1. I am the mother father CASE NO. PARENT'S CONSENT TO APPOINTMENT OF A GUARDIAN of the minor child named above. My full name is Mailing Address (box or street number) (city) (state) (ZIP) Daytime Telephone Number 2. The child's other parent is the Full name Mailing Address (box or street number) (city) (state) (ZIP) mother father Daytime Telephone Number 3. 4. I am over 18 years of age. I understand that a petition has been or will be filed asking the court to appoint a guardian for the child named above because my parental rights have been suspended by circumstances and the child's other parent is not able to take care of this child. I agree that I am not able to take care of the child at this time. The reason for this is (give specific details) 5. 6. 7. I agree that it is in my child's best interests for the court to appoint as the child's guardian. I understand that the guardian will have almost the same powers and duties as a parent (except that the guardian is not legally obligated to use his or her own money to support the child). I understand that, during the guardianship, my parental rights will be suspended, but not my duty to provide financial support for the child. American LegalNet, Inc. www.FormsWorkFlow.com 8. Page 1 of 2 PG-615 (2/17)(cs) PARENT'S CONSENT TO APPOINTMENT OF A GUARDIAN Probate Rule 15(b) AS 13.06.115 & AS 13.26.132- .147 9. I understand that the court may make changes in the guardianship order in the future if the court decides it is in the child's best interests. I also understand that I can request a review hearing and ask the court to change or end the guardianship order. However, the court will decide whether or not to change or end the guardianship based on the child's best interests. [Form PG-190 can be used to make the request. Court addresses are on the court website: www.courts.alaska.gov.] 10. I understand that the court will hold a hearing to decide whether to appoint a guardian and that I am entitled to attend this hearing and to speak at the hearing. I want to receive notice of the time and place of the hearing. I do not want to receive notice about the hearing. 11. Indian Child or Parent. a. The child named above is is not an Indian or Alaska Native child.1 Name of child's tribe or Native village: b. I am am not a member of an Indian tribe. Tribe Name ) is is not c. The child's other parent (name a member of an Indian tribe. Tribe Name d. I understand that if the child is an Indian child (as defined in the Indian Child Welfare Act), notice of the guardianship hearing must be given to the child's tribe, and the tribe may intervene in the case. However, I also understand that it is not necessary to give notice to the tribe if the parents of the child agree in writing to the guardianship and file a statement that the tribe has not been served with notice in order to protect the privacy of the parents. Please serve a notice of hearing on the child's tribe In order to protect my privacy, please do not serve the tribe with notice. Date Subscribed and sworn to or affirmed before me at on . Date (SEAL) Signature of Parent , Alaska Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: 1 "Indian Child" means any unmarried person who is under age eighteen and is either (a) a member of an Indian tribe or (b) is eligible for membership in an Indian tribe and is the biological child of a member of an Indian tribe." 25 USC §1903(4). Note: "Indian tribe" includes Alaskan Native villages as defined in 43 USC 1602(c). American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 PG-615 (2/17)(cs) PARENT'S CONSENT TO APPOINTMENT OF A GUARDIAN Probate Rule 15(b) AS 13.06.115 & AS 13.26.132- .147