THIS FORM MUST BE SIGNED IN FRONT OF A NOTARY.

Once you complete the form, print it out and sign it in front of a notary. The parent's original signature and the
notary's stamp and signature must appear on the document that is filed with the court.

CONS
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: ______________________________
Email: ______________________________
Self-Represented

DISTRICT COURT
CLARK COUNTY, NEVADA

In the Matter of the Guardianship of the:

 Person CASE NO.: ____________________
 Estate
DEPT: ____________________
 Person and Estate
of:
____________________________________
(name of child who needs a guardian)
A Proposed Protected Minor.

CONSENT AND WAIVER OF PARENT

I, (name of parent signing) _______________________________________, declare that

I am the ( check one)  mother /  father of the above-named child who is the subject of
the above-captioned guardianship matter;
I hereby join Petitioner(s) in the Petition for Appointment of Guardian(s) and consent to
having (name of proposed guardian) _______________________________________ and
(second proposed guardian, or “n/a” if none) _____________________________________
appointed as legal guardian(s) of the above named child; and
I hereby waive service of the Citation to Appear and Show Cause regarding the Petition
for Appointment of Guardian(s) in this case, or state that no Citation is necessary pursuant to
2017 Nevada Laws Ch. 172 § 35 (A.B. 319).

DATED (month) ________________________ (day) _______, 20___.

(Signature)

(Printed Name)

© 2017 Family Court Self-Help Center Parent Consent (1 Child)

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STATE OF ____________________ )
)
COUNTY OF __________________ )

The foregoing Consent and Waiver of Parent was signed and sworn to before me by

(name of parent signing) ________________________________________________________

on the _____ day of ________________________, 20___.

__________________________________________
NOTARY PUBLIC

© 2017 Family Court Self-Help Center Parent Consent (1 Child)

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