Form 124 Rev 03/15 The Family Court of the State of Delaware In and For New Castle Kent Sussex County CONSENT ORDER ­ GUARDIAN OF THE PERSON Petitioner Name Street Address (including Apt) Respondent Name Street Address (including Apt) File Number P.O. Box Number City/State/Zip Code Date of Birth P.O. Box Number City/State/Zip Code Date of Birth Case Number 2nd Petitioner (If any) Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Date of Birth 2nd Respondent (If any) Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Date of Birth IN THE INTEREST OF THE FOLLOWING CHILD(REN): (Complete the table below for each child for which petitioner wants guardianship. Attach additional sheets if necessary.) Child's Name Child's Date of Birth Child's Place of Birth (City, State) Child's Gender (Check one) Male Male Male Female Female Female Petitioner's relationship to the child(ren) (select one relationship from choices below) brother or sister grandparent or great-grandparent aunt or uncle first cousin grandaunt or granduncle half-brother or half-sister other relative non-relative The parties in the above entitled cause agree upon the following arrangement and do consent to the entry of an Order providing for same: GUARDIANSHIP AWARDED TO: with the powers and duties set forth in 13 DEL. C. § 2340, a copy of which is attached to this order. Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 124 Rev 03/15 Respondent(s) shall have visitation as follows: BE IT REMEMBERED, that on this date, , , ("Petitioner"), who, being duly sworn by me according to the law personally appeared before me, a Notary Public for the State and County declared above, did depose and say: We, the undersigned, hereby agree upon the following guardianship agreement for the above-named child. We signed this consent agreement voluntarily and of our own free will. THE RESPONDENTS ACKNOWLEDGE THAT EACH WAS ADVISED THAT IF HE/SHE IS INDIGENT AND WISH TO HAVE COURT APPOINTED COUNSEL REPRESENT HIM/HER IN THIS ACTION, COUNSEL WOULD BE APPOINTED FOR HIM/HER. HE/SHE FREELY AND VOLUNTARILY WAIVES HIS/HER RIGHT TO COUNSEL. This agreement of the parties is subject to review of the parties' criminal histories by a hearing officer before entry as an order of the court. NOTICE ­ This agreement of the parties, if filed by a non-relative as defined in 10 Del. C. § 901, is subject to an assessment conducted by the Department of Services for Children, Youth and Their Families, as required by 31 Del. C. § 351. I hereby waive my right to a Review of a Commissioner's Order because this Order is entered pursuant to this Voluntary Agreement. Child (if over 14 years of age) (Signature) Petitioner (Signature) Respondent (Signature) Child (if over 14 years of age) (Print) Petitioner (Print) Respondent (Print) Additional Child(ren) (Signature) (if necessary) 2nd Petitioner (Signature) (if any) 2nd Respondent (Signature) (if any) Additional Child(ren) (Print) (if necessary) 2nd Petitioner (Print) (if any) 2nd Respondent (Print) (if any) SWORN TO AND SUBSCRIBED before me this date, Mediation Officer/Notary Public/Clerk of Court SO ORDERED this day of , Judge/Commissioner Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 124 Rev 03/15 TITLE 13 Domestic Relations CHAPTER23.GUARDIANSHIPOFACHILD SubchapterIV.PowersandDutiesofaGuardian § 2340. Powers and duties of the guardian of the child. (a) The Court shall grant to the guardian of the child such powers, rights and duties which are necessary to protect, manage and care for the child. (b) The guardian of the child may exercise the same powers, rights and duties respecting the care, maintenance and treatment of the child as a parent would, except that the guardian of the child is not liable to third persons for acts of the child solely by reason of the guardianship relationship. (c) Except as modified by the order of guardianship and without qualifying the foregoing, a guardian of the person has the following powers and duties: (1) The guardian is entitled to custody of the child and may establish the child's place of abode within or without this State. (2) The guardian shall provide the child with: a. A physically and emotionally healthy and safe living environment and daily care; b. Education; and c. All necessary and appropriate medical treatment, including but not limited to medical, dental and psychiatric examinations, treatment and/or surgery. (3) The guardian shall make decisions regarding: a. Education; b. Travel; c. All necessary and appropriate medical treatment, including but not limited to medical, dental and psychiatric examinations, treatment and/or surgery; d. The child's right to marry or enlist in the armed forces; e. Representation of the child in legal actions; and f. Any other matter that involves the child's welfare and upbringing. (4) The guardian shall: a. Be responsible for the health, education and welfare of the child; b. Comply will all terms of any Court order to provide the child's parents with visitation, contact or information. (d) The Court, in its discretion, may expressly limit the duties and powers of the guardian as set forth in this chapter. (e) No bond shall be required from any guardian appointed under this chapter. 73 Del. Laws, c. 150, § 1; 73 Del. Laws, c. 360, § 5.; American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3