Form 126S (Rev. 06/10) The Family Court of the State of Delaware In and For Petitioner Name Street Address P.O. Box Number City/State/Zip Code Phone Number Relation to Child(ren) D.O.B. New Castle Kent Sussex County PETITION FOR STANDBY GUARDIANSHIP OF A MINOR Respondent Name Street Address P.O. Box Number City/State/Zip Code Phone Number Relation to Child(ren) D.O.B. File Number Petition Number Attorney Name Attorney Name ) ) No No If a hearing is scheduled in this matter, will Petitioner need an interpreter? Yes (If yes, specify language If a hearing is scheduled in this matter, will Respondent need an interpreter? Yes (If yes, specify language 2nd Petitioner (if any) Name Street Address P.O. Box Number City/State/Zip Code Phone Number D.O.B. 2nd Respondent (if any) Name Street Address P.O. Box Number City/State/Zip Code Phone Number D.O.B. Relation to Child(ren) Relation to Child(ren) Attorney Name Attorney Name ) ) No No If a hearing is scheduled in this matter, will Petitioner need an interpreter? Yes (If yes, specify language If a hearing is scheduled in this matter, will Respondent need an interpreter? Yes (If yes, specify language Guardian Ad Litem (if any) Name Street Address P.O. Box Number City/State/Zip Code Home Phone Number Work Phone Number Attorney Name If a hearing is scheduled in this matter, will Guardian Ad Litem need an interpreter? Yes (If yes, specify language ) No 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Form 126S (Rev. 06/10) IN THE INTEREST OF THE FOLLOWING CHILD(REN): (Complete the table below for each child for whom Standby Guardianship is sought. 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 1. Complete the table below regarding the child(ren)'s parents (individuals holding parental rights): NAME Address Date of Birth MOTHER FATHER 2. If you do not know the name/address of the child(ren)'s mother and/or father, write in the space provided below what you have done to try to locate him/her/them. I have attached to this Petition the following affidavits: Affidavit that a Party's Address is Unknown 3. Name(s) of the person(s) or organization holding parental rights of the child(ren): Address of person(s) or organization: 4. Name(s) of the person(s) or organization having the guardianship, care, control or custody of the child(ren): Address of person(s) or organization if address is different from address of Petitioner(s): 5. Name(s) of the person(s) to whom standby guardianship shall be vested if this Petition is granted Address of person(s) or organization if address is different from address of Petitioner(s): 6. Proposed guardian(s)' relationship to child(ren) if proposed guardian is NOT the Petitioner: 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Form 126S (Rev. 06/10) 7. Please check all that apply: The following child(ren) is/are not yet 14 years of age or older: OR The child(ren) is/are 14 years of age or older and consents to (agree with) this Petition (Attach Affidavit of Consent executed by each child(ren) who consents) Name(s) of child(ren) 14 years of age or older who consent(s): The child(ren) is/are 14 years of age or older does/do NOT consent to (agree with) this Petition. Name(s) of child(ren) 14 years of age or older who do NOT consent: 8. I am filing this petition because: (Check ALL that apply) The child(ren)'s parent(s) agree that I/we should become the guardian(s) of the child(ren) (Attach an Affidavit of Consent executed by the parent(s) who agree). The child(ren)'s parent(s) are deceased. (Attach a certified copy of the death certificate) The child(ren) is/are dependant and/or neglected based on the following reason(s): It is in the child(ren)'s best interest to appoint the above referenced standby guardian because: 9. The proposed standby guardian's qualifications to serve are as follows: 10. The triggering event(s) that shall cause the authority of the standby guardian to become effective are as follows: 11. There is a significant risk that the parent, custodian or guardian will die, become incapacitated or become debilitated within two (2) years of the filing of this petition. I have attached supporting documentation from the attending physician as defined by 13 Del.C. §2362. 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Form 126S (Rev. 06/10) 12. Name(s) of the person(s) to whom standby guardianship shall be vested as an alternate if the person named in this Petition is unable to serve: Address of person(s): above referenced 13. The qualifications of the above referenced alternate stand-by guardian are as follows: WHEREFORE, Petitioner(s) seek appointment of named minor child(ren). as Standby Guardian(s) of the above Petitioner Sworn to subscribed before me: Date 2nd Petitioner (if any) Sworn to subscribed before me: Date Clerk of Court/Notary Public Date Clerk of Court/Notary Public Date 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com