Free Agreement Nonparent Relative Caregiver PDF Template
Outline
When a parent finds themselves in a situation where they must entrust the care of their child to a nonparent relative or a voluntary caregiver, the legal framework of this arrangement becomes paramount. This is where the Authorization Agreement for Nonparent Relative or Voluntary Caregiver comes into play, offering a structured and legally sound way to grant temporary caregiving rights to someone other than the child's parent. Designed with the safety and well-being of the child in mind, this agreement outlines specific authorities granted to the caregiver, including the ability to make medical decisions, enroll the child in school, and apply for public benefits on behalf of the child, among others. Notably, it respects the parent's continuous legal rights, allowing for the termination of the agreement and the reclaiming of custody at any moment. This document, steeped in the legal considerations of Chapter 34 of the Texas Family Code, is a safety net for those situations where a parent willingly authorizes a trusted relative or friend to temporarily assume significant responsibilities for their child's wellbeing, emphasizing the importance of communication, legality, and clarity in arrangements that diverge from traditional parental care.
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AUTHORIZATION AGREEMENT FOR NONPARENT RELATIVE OR VOLUNTARY CAREGIVER
August 2011 Page 1 of 4
This authorization agreement is made in conformance with Chapter 34 of the Texas Family Code concerning the following Child:
Child's Full Name:
Date of Birth:
Parent completing this form:
Full Name:
Physical Address:
Telephone Number:
Other contact information:
Child's other parent:
Full Name:
Physical Address:
Telephone Number:
Other contact information:
Parent voluntarily authorizes the following relative or Parental Child Safety Placement voluntary caregiver to make certain decisions regarding the child, as listed on the next page of this authorization agreement.
Name:
Relationship to Child (check one):
Child's Grandparent 
Child's Adult Sibling 
Child's Aunt or Uncle
Parental Child Safety Placement Voluntary Caregiver in accordance with Child Protective Services
Physical Address:
Telephone Number:
Other contact information:
PARENT AND RELATIVE OR VOLUNTARY CAREGIVER UNDERSTAND THAT THEY ARE REQUIRED BY LAW TO IMMEDIATELY PROVIDE EACH OTHER WITH INFORMATION REGARDING ANY CHANGE IN THE OTHER PARTY'S ADDRESS OR CONTACT INFORMATION.
AUTHORIZATION AGREEMENT FOR NONPARENT RELATIVE OR VOLUNTARY CAREGIVER
August 2011 Page 2 of 4
Parent authorizes the above named relative or voluntary caregiver to perform the following acts in regard to the child and the relative or voluntary caregiver assumes the responsibility of performing these functions:
(1)To authorize medical, dental, psychological, surgical treatment, and immunization of the child, including executing any consents or authorizations for the release of information as required by law relating to the treatment or immunization;
(2)To obtain and maintain health insurance coverage for the child and automobile insurance coverage for the child, if appropriate;
(3)To enroll the child in a
(4)To authorize the child to participate in
(5)To authorize the child to obtain a learner's permit, driver's license, or
(6)To authorize employment of the child; and
(7)To apply for and receive public benefits on behalf of the child.
(8)This authorization agreement does not confer on the relative or voluntary caregiver of the child the right to authorize the performance of an abortion on the child or the administration of emergency contraception to the child
To the best of the parent's and the relative's or voluntary caregiver's knowledge (check if applicable):
This child is not the subject of a current
To the best of the parent's and the relative's or voluntary caregiver's knowledge (choose one from below):
THERE IS NO COURT INVOLVEMENT WITH THIS CHILD
All of the following statements must apply:
•There is no court order or pending suit affecting the
•There is no pending litigation in any court concerning custody, possession, or placement of the child or access to or visitation with the child.
•The court does not have continuing jurisdiction concerning the child.
THIS CHILD HAS BEEN THE SUBJECT OF A COURT ACTION
The court with continuing jurisdiction concerning the child has given written approval for the execution of the authorization agreement accompanied by the following information:
•The county in which the court is located;
•The number of the court; and
•The cause number in which the order was issued or the litigation is pending. Please staple a copy of the court's order to this agreement.
AUTHORIZATION AGREEMENT FOR NONPARENT RELATIVE OR VOLUNTARY CAREGIVER
August 2011 Page 3 of 4
WARNINGS AND DISCLOSURES
This authorization agreement is an important legal document. The parent and the relative or voluntary caregiver must read all of the warnings and disclosures before signing this authorization agreement.
The parent and relative are not required to consult an attorney but are advised to do so.
A parent's rights as a parent may be adversely affected by placing or leaving the parent's child with another person.
This authorization agreement does not confer on the relative or voluntary caregiver the rights of a managing or possessory conservator or legal guardian.
A parent who is a party to this authorization agreement may terminate the authorization agreement and resume custody, possession, care, and control of the child on demand and at any time the parent may request the return of the child.
Failure by the relative or voluntary caregiver to return the child to the parent immediately on request may have criminal and civil consequences.
Under other applicable law, the relative or voluntary caregiver may be liable for certain expenses relating to the child in the relative's or voluntary caregiver's care, but the parent still retains the parental obligation to support the child.
In certain circumstances, this authorization agreement may not be entered into without written permission of the court. Examples of when court permission must be granted include when a court has entered a previous order granting custody or establishing a child support obligation.
This authorization agreement may be terminated by certain court orders affecting the child.
This authorization agreement does not supersede, invalidate, or terminate any prior authorization agreement regarding the child.
This authorization agreement is void if a prior authorization agreement regarding the child is in effect and has not expired or been terminated.
MAILING REQUIREMENTS:
When both parents do not sign the parent authorization agreement, a copy of the agreement MUST be mailed to the
1.The parties mail a copy of this agreement to a
2.If the parties do not receive a response from the
EXCEPTION TO MAILING REQUIREMENTS:
If a parent who did not sign the authorization agreement does not have
1.A protective order has been issued against the
AUTHORIZATION AGREEMENT FOR NONPARENT RELATIVE OR VOLUNTARY CAREGIVER
August 2011 Page 4 of 4
who signed the agreement or any child of the parent who signed the agreement; or
2.The
kidnapping, assault and sexual assault); or
O any other criminal offense in Texas or any other state if the offense involves a violent act or prohibited sexual conduct.
This authorization agreement (select one of the following two):
Expires on this date: |
OR |
Is valid until revoked in writing by either party
In addition, check here if you want the agreement to continue in effect after your death or during any period of incapacity. 
Execution of a subsequent authorization agreement does not by itself supersede, invalidate, or terminate a prior authorization agreement.
By signing below, parent and the relative or voluntary caregiver acknowledge that they have each read this authorization agreement carefully, are entering into the authorization agreement voluntarily, and have read and understand all of the Warnings and Disclosures included in this authorization agreement.
_____________________________________
PARENT
Printed name:
SUBSCRIBED AND ACKNOWLEDGED BEFORE ME on this ____ day of _________________, 20____.
_____________________________________
Notary Public in and for the State of TEXAS
_____________________________________
PARENT**
Printed name:
SUBSCRIBED AND ACKNOWLEDGED BEFORE ME on this ____ day of _________________, 20____.
_____________________________________
Notary Public in and for the State of TEXAS
_____________________________________
RELATIVE OR VOLUNTARY CAREGIVER
Printed name:
SUBSCRIBED AND ACKNOWLEDGED BEFORE ME on this ____ day of _________________, 20____.
_____________________________________
Notary Public in and for the State of TEXAS
Document Attributes
| Fact Number | Fact Detail |
|---|---|
| 1 | This form is governed by Chapter 34 of the Texas Family Code. |
| 2 | The form allows a parent to authorize a nonparent relative or voluntary caregiver to make certain decisions for a child. |
| 3 | Decisions authorized include medical treatment, insurance coverage, education enrollment, extracurricular activities participation, and application for public benefits. |
| 4 | This authorization does not allow the relative or caregiver to consent to an abortion or emergency contraception for the child. |
| 5 | Mailing requirements are specified for cases where both parents do not sign the authorization, including exceptions for situations involving family violence or certain criminal convictions. |
| 6 | The agreement can be terminated at any time by the parent, can expire on a specified date, or remain valid until revoked in writing by either party. |
How to Fill Out Agreement Nonparent Relative Caregiver
Filling out the Authorization Agreement for Nonparent Relative or Voluntary Caregiver form is a critical step in ensuring the welfare of a child under circumstances where a parent cannot be present for various reasons. It allows a designated relative or a voluntary caregiver the authority to make decisions for the child's educational, medical, and overall well-being needs in alignment with Texas Family Code Chapter 34. It's vital to approach this document with care, understanding that it can be revised or revoked by the parent at any time to reclaim custodial rights. The outlined steps below are designed to guide you through each part of the form to avoid common mistakes and ensure that the agreement is legally binding.
- Start by entering the full legal name and date of birth of the child on the top part of Page 1. This identifies the child under the agreement's consideration.
- Fill in your full name, physical address, and telephone number under "Parent completing this form." Include any other contact information requested. If there is another parent involved, complete their information following yours.
- Select the appropriate relationship to the child for the volunteer caregiver or relative—options include grandparent, adult sibling, or aunt/uncle, among others.
- List the full name, physical address, telephone number, and any additional contact information for the relative or voluntary caregiver authorized under this agreement.
- On Page 2, carefully read and understand the list of specific authorizations you are granting to the caregiver, from medical treatments to school enrollment and more. Acknowledge each item carefully to ensure you agree with the permissions being granted.
- Check the appropriate statement under "To the best of the parent's and the relative's or voluntary caregiver's knowledge" regarding the child's current legal and custodial status.
- Review and check if court involvement is applicable, providing detailed information if a court action has previously been initiated concerning the child. Attach any related court order as required.
- Thoroughly read through the Warnings and Disclosures on Page 3, understanding the legal implications, responsibilities, and liabilities assumed under this agreement.
- Assess the mailing requirements section to determine if a copy of the agreement needs to be sent to a non-signing parent. Follow through with mailing procedures as prescribed, if applicable. This step ensures the agreement's legality and protects against future disputes.
- Decide on the duration of the agreement – whether it expires on a specific date or remains valid until revoked. Optionally, consider whether the agreement should continue beyond your death or during a period of incapacity.
- Sign and date the agreement in the presence of a Notary Public, ensuring that the relative or voluntary caregiver does the same. All signatures must be notarized to validate the agreement.
Upon completion, this form establishes a legal framework allowing a designated caregiver to legally act on behalf of the child's needs. Keeping a copy for your records and providing one to the caregiver ensures that all parties understand their rights and responsibilities. This formal agreement is an essential tool for ensuring the child's safety, health, and well-being in the parent's absence, providing peace of mind to all involved.
More About Agreement Nonparent Relative Caregiver
What is an Authorization Agreement for Nonparent Relative or Voluntary Caregiver?
This is a legal document that allows a parent to authorize a nonparent relative or a voluntary caregiver to make certain decisions for their child. These decisions can include medical treatment, enrollment in school, participation in extracurricular activities, and more, in compliance with Chapter 34 of the Texas Family Code.
Who can be authorized as a nonparent relative or voluntary caregiver?
A nonparent relative or voluntary caregiver can be the child's grandparent, adult sibling, aunt, uncle, or a caregiver chosen without the involvement of Child Protective Services, who is willing to assume responsibility for the child. The relationship to the child must be checked accordingly on the form.
What powers does this agreement grant?
It allows the designated relative or caregiver to authorize medical treatments, obtain health and auto insurance, enroll the child in educational programs, authorize employment, and apply for public benefits, among other responsibilities. However, it doesn’t allow them to consent to an abortion or the administration of emergency contraception to the child.
Does this agreement affect the parental rights of the parent?
Parents retain their rights and may resume custody of their child at any time. The agreement explicitly states that it does not grant the caregiver the rights of a managing or possessory conservator or legal guardian. Parents are advised, though not required, to consult an attorney due to the potential legal implications.
Can this agreement be terminated?
Yes, a parent who is a party to this authorization agreement can terminate it and demand the return of their child at any time. The document underlines that failure to return the child upon request may lead to criminal and civil consequences.
What are the requirements if one parent does not sign the agreement?
If only one parent signs the agreement, a copy must be mailed to the non-signing parent by certified mail, return receipt requested, within 10 days after the agreement is signed. If there's no response, a second copy must be sent by first-class mail within 45 days. Exceptions apply if the non-signing parent has committed acts of family violence or is convicted of certain crimes.
Is court approval required for this agreement?
In some situations, yes. Court permission is necessary if a court order concerning custody or child support exists, or if there's ongoing litigation regarding the child. If the child is under court jurisdiction, written approval from the court is required for the agreement to be valid.
How long does the authorization agreement last?
The duration can be specified by date or remain in effect until revoked in writing by either party. Additionally, parties can agree for it to continue even after the death or incapacity of the parent.
What should be done if the circumstances of either party change?
Both parties are required by law to immediately inform each other of any changes in their contact information or circumstances that could affect the agreement. This ensures that all parties remain informed and the child’s needs are adequately met.
Common mistakes
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One common mistake is not providing accurate or complete names and contact information for all parties involved. When filling out the form, every field asking for the full name, physical address, telephone number, and other contact information of the parent, the child, and the relative or voluntary caregiver needs to be filled in carefully. Leaving a section blank or inputting incorrect information could lead to misunderstandings or legal complications down the line. This includes checking the relationship to the child box accurately to reflect the true relationship between the child and the caregiver.
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Another error occurs when individuals do not properly address the legal status of the child, especially concerning court involvement. It’s important to check one of the boxes that accurately describe the child's current legal situation, whether there’s no court involvement or if the child has been the subject of court action. If there’s any court involvement, attaching a copy of the court's order to this agreement is a must. Overlooking this step can make the agreement invalid or lead to legal repercussions.
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Failure to mail a copy of the agreement to a non-signing parent, when required, is another oversight. This step is crucial when both parents do not sign the authorization agreement. The form outlines specific mailing requirements, including timelines and the type of mail to be used. Missing these steps or deadlines can invalidate the entire agreement. This includes mailing a second copy if there’s no response from the non-signing parent within a certain timeframe.
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Lastly, a mistake often made is not properly dealing with the agreement's duration and termination clauses. The form provides options for the agreement to either have an expiration date or remain valid until revoked in writing. Also, there’s an option for the agreement to continue even after the death or incapacity of the parent. Not correctly marking these options or ignoring them can lead to confusion and disputes about the authority and responsibilities granted to the caregiver.
Documents used along the form
When individuals are completing an Authorization Agreement for Nonparent Relative or Voluntary Caregiver, it's vital to understand that this document does not stand alone in the scope of legal and administrative procedures. Several other forms and documents are commonly required to ensure comprehensive legal coverage and to support the agreement fully. These forms play a crucial role in ensuring the child's welfare and the legal rights and responsibilities of all parties involved are clearly defined and protected.
- Child's Birth Certificate: This is a critical document to establish the child's identity and to substantiate the relationship between the child and the nonparent caregiver. It may be required for enrollment in school, obtaining medical insurance, and for various state and federal benefits.
- Medical Consent Form: While the Authorization Agreement for Nonparent Relative or Voluntary Caregiver does include provisions for medical care, a separate medical consent form may be needed for particular medical treatments or to satisfy the requirements of certain medical practices or hospitals.
- School Enrollment Forms: To enroll the child in a new school or to transfer them to a school closer to the nonparent caregiver, official forms from the educational institution will need to be completed. These often require information on the child's educational history, immunization records, and documentation of legal guardianship or caregiver authority.
- Power of Attorney for Childcare: This document can provide broader legal authority for a nonparent caregiver to make decisions on behalf of the child. It can complement the authorization agreement in scenarios where more extensive powers are needed or for specific purposes not covered by the original agreement.
- Proof of Residence: Utility bills, lease agreements, or homeowner documents are often necessary to prove the caregiver's residence. This is particularly important for school enrollment and may also be required for various state or federal benefits programs.
Understanding the interplay and necessity of these documents in conjunction with the Authorization Agreement for Nonparent Relative or Voluntary Caregiver can significantly smooth the legal and administrative processes involved. Each document serves to protect the interests of the child and ensure their care and development needs can be met effectively by the nonparent caregiver. Legal guidance can be invaluable in navigating these requirements to ensure that all preparations are thorough and compliant with state laws and regulations.
Similar forms
Power of Attorney for Child Care: This document, similar to the Authorization Agreement for Nonparent Relative or Voluntary Caregiver, gives an adult authority to make decisions regarding a child's care, education, and medical treatment in the absence of the child's parents. Both outline specific permissions and responsibilities delegated to a named individual for the welfare of a child.
Medical Consent Form for a Minor: Similar to sections of the authorization agreement, this form allows a designated adult to consent to medical, dental, and psychological treatment for a minor. Both ensure a child receives timely care when the parent is not available to give consent.
Educational Guardian Form: Like the authorization agreement, this document permits a named guardian to enroll a child in school and make decisions regarding their education. It allows a nonparent relative or caregiver to manage the child's educational needs and extracurricular activities.
Child Travel Consent Form: While focused on travel, this document is similar as it grants a caregiver the authority to travel with a child and make decisions on their behalf, analogous to the authorization agreement enabling participation in activities and certain permissions while under the caregiver's supervision.
Temporary Guardianship Agreement: Similar to the authorization agreement, this legal document temporarily grants a guardian rights to care for a child in the parents' absence. Both forms ensure the child's welfare is managed by someone the parents trust.
Child Custody Agreement: Relates closely to the authorization agreement in terms of outlining the care and custody arrangements for a child, albeit usually in a more permanent arrangement or as part of a divorce or separation proceeding.
Child Support Agreement: Though primarily focused on financial arrangements, it's akin to the authorization agreement in that it involves agreements between parents (and sometimes nonparents) regarding the child's welfare.
Voluntary Placement Agreement: Similar to the authorization agreement, this document is used when parents voluntarily place their child in the care of another party, often in foster care or for adoption, detailing care and visitation rights.
Consent Form for Minor Work Permit: Much like the section of the authorization agreement that allows for the authorization of employment, this document grants permission for a minor to be employed and outlines conditions of such employment.
Dos and Don'ts
When completing the Authorization Agreement for Nonparent Relative or Voluntary Caregiver form, several steps should be followed to ensure the process is conducted properly, and some pitfalls should be avoided. Here's a comprehensive guide:
Things You Should Do:
- Read the entire document carefully before signing. This agreement carries significant legal implications, and understanding all sections is crucial.
- Ensure all information is accurate, especially names, addresses, and contact details of the child, parent, and caregiver to avoid any misunderstandings or legal issues.
- Check the legal status of the child with respect to any ongoing court actions or orders. This information must be accurately reflected in the document to avoid legal complications.
- Consult with an attorney if you have any doubts or questions. While not mandatory, getting legal advice can help you understand the implications of the agreement better.
- Notify the non-signing parent if required. If one parent doesn't sign the agreement, follow the mailing requirements meticulously to adhere to legal standards.
- Keep copies of the signed agreement for your records. Both the caregiver and the parent should have a copy to refer back to if needed.
Things You Shouldn't Do:
- Do not rush through the process. Filling the form out hastily can lead to mistakes that might confuse or nullify the agreement's intentions.
- Avoid leaving blank spaces. Incomplete forms may be considered invalid or require resubmission, delaying the caregiving arrangement.
- Do not forget to check the appropriate boxes regarding the child's current legal and custody status to ensure the form is filled out in compliance with state laws.
- Do not ignore the requirement to staple a copy of the court's order if the child has been the subject of court action. Failing to attach necessary documents may invalidate the agreement.
- Do not assume the agreement grants full legal guardianship or conservatorship rights. Understand the specific powers and limitations the agreement provides to the caregiver.
- Do not forget to terminate the agreement properly if needed. Both parties should be clear on the process for ending the agreement if the arrangement changes.
Misconceptions
Many people have misconceptions about the Authorization Agreement for Nonparent Relative or Voluntary Caregiver form. Let's clear up some of the most common misunderstandings:
The form permanently transfers parental rights: This agreement does not transfer parental rights permanently to the caregiver. It allows the caregiver to make certain decisions for the child, but the parent retains their parental rights and responsibilities.
Only relatives can be authorized caregivers: While the form is primarily designed for relatives, it also allows for a voluntary caregiver, who is not a relative, to be authorized under certain circumstances, in accordance with Child Protective Services.
Signing the agreement is irrevocable: A parent can revoke the authorization at any time and demand the return of their child. This flexibility ensures parents are not permanently relinquishing their rights or control.
The caregiver has the right to authorize all medical procedures: While the caregiver can authorize medical treatments, the agreement specifically excludes the authorization for an abortion or the administration of emergency contraception.
The form is valid without court approval: In cases where there is court involvement with the child, court permission might be necessary to validate the agreement, especially if a court order granting custody or establishing child support obligations exists.
All decisions regarding the child can be made by the caregiver: The caregiver is authorized to make decisions in specific areas such as medical treatment, education, and certain legal matters but does not gain full legal guardianship or the ability to make all decisions regarding the child.
There's no need to inform the non-signing parent: If both parents do not sign the agreement, the non-signing parent must be mailed a copy of the agreement unless that parent is deceased or has had parental rights terminated. This ensures transparency and legal adherence.
The agreement covers financial responsibilities for the child: While the caregiver assumes certain responsibilities, the agreement does not relieve the parent of their financial obligations to support the child. Parents maintain their duty to provide financial support.
The agreement expires automatically: The agreement remains in effect until it is revoked in writing by either party. Additionally, parties can specify an expiration date or opt for the agreement to continue beyond the death or incapacity of the parent.
Understanding these key points helps clarify the purpose and limitations of the Authorization Agreement for Nonparent Relative or Voluntary Caregiver, ensuring that all parties are well-informed before entering into such an agreement.
Key takeaways
Understanding how to correctly fill out and use the Authorization Agreement for Nonparent Relative or Voluntary Caregiver form is essential for the care and safety of the child involved. Here are key takeaways to help you navigate this process:
- The form is designed in accordance with Chapter 34 of the Texas Family Code, ensuring its legal grounding for the care of a child by a nonparent relative or voluntary caregiver.
- It requires detailed information about the child, the parent completing the form, the child’s other parent, and the designated nonparent caregiver, including their names, physical addresses, telephone numbers, and other contact information.
- Parents can authorize the named relative or voluntary caregiver to make various decisions and perform specific acts for the child, such as authorizing medical treatments, enrolling the child in school, and applying for public benefits.
- The agreement explicitly does not allow the authorized individual to consent to an abortion or the administration of emergency contraception for the child.
- Both parties must be fully aware of the child's current legal and custody status, ensuring there are no conflicting agreements or court orders.
- Warnings and disclosures outlined in the agreement emphasize the importance of understanding the legal implications, advising both the parent and the relative or caregiver to consider legal counsel.
- This agreement can significantly affect parental rights and responsibilities, including the immediate return of the child upon the parent's demand.
- Mail requirements dictate that a copy of the agreement must be sent to any non-signing parent, with specific instructions on how and when to do so, unless legal exceptions apply.
- The form outlines the conditions under which it can be terminated or voided, including by court orders or failure to adhere to mailing requirements.
- Both parties must sign the agreement before a Notary Public, affirming they understand and voluntarily enter into the agreement, and acknowledging the potential for the agreement to remain in effect after the parent's death or during incapacitation unless revoked in writing.
These key takeaways should help guide parents and nonparent caregivers through the necessary steps to ensure the agreement is properly completed and legally effective, safeguarding the child's wellbeing and the rights of all parties involved.
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