Riverside local form RI-PR111

Source: https://www.riverside.courts.ca.gov/system/files/2026-03/RI-PR111.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE

MURRIETA 30755-D Auld Rd., Murrieta, CA 92563 RIVERSIDE 4050 Main St., Riverside, CA 92501 PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RI-PR111

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY

CONFIDENTIAL

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

IN THE MATTER OF:

CASE NUMBER:

Hearing Date: Time: Department:

NOMINATION OF JOINT GUARDIAN
FORM GC-210(P) – ATTACHMENT 10c(1)

1. My name is: .

2. I am a parent who has custody of my child (name): .

3. I nominate the following person(s) as joint guardian of the person of my child:
a. (Name):
(Address):
(Phone):
(Email):

b. (Name):
(Address):
(Phone):
(Email):

4. This nomination will be effective (Complete either (a) or (b)):
a. Immediately

b. If I become unavailable due to (check all that apply)

(1) A serious medical condition or disability
(2) Military service
(3) Incarceration
(4) Deportation or immigration-related detention
(5) Death
(6) Other (specify):

Approved for Optional Use NOMINATION OF JOINT GUARDIAN https://riverside.courts.ca.gov Riverside Superior Court Form RI-PR111 [New 01/14/26] FORM GC-210(P) – ATTACHMENT 10c(1)

IN THE MATTER OF: CASE NUMBER:

5. Tribal Membership Status (Complete either (a) or (b)):
a. Non-Tribal Status: Neither I, the other parent, or the child are members are eligible for membership
in a federally-recognized Indian tribe.

b. Tribal Status: I am, the other parent is, and/or my child is a member or eligible for
membership in a federally-recognized Indian tribe. I signed this consent at least 10 days after the
child’s birth before the judge indicated below.

Judicial Certification under Probate Code 1500.1: This nomination was signed before:
Judge (name):

Court (name):

The judge certifies by the signature below that the terms and consequences of the consent were fully
explained in detail and fully understood
in English
through an interpreter in (language):

Date:
(SIGNATURE OF JUDGE)

6. Status of the other parent (Select one):
a. Deceased

b. Lacks legal capacity

c. Parental rights have been terminated by a court

d. Consents to this nomination

e. Consent status in unknown

Date: (SIGNATURE OF NOMINATING PARENT)

(TYPED NAME OF NOMINATING PARENT)

Approved for Optional Use NOMINATION OF JOINT GUARDIAN https://riverside.courts.ca.gov Riverside Superior Court Form RI-PR111 [New 01/14/26] FORM GC-210(P) – ATTACHMENT 10c(1)