TEMPORARY CUSTODY AGREEMENT

I, ____________________________, the custodial parent of the following child(ren):
(Please give full names and date of birth)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
do hereby give temporary custody to (name and relationship to the children) ________________________
__________________________________________________________________________.
I currently reside at ________________________________________________________ and
Mr./Mrs. ________________ currently resides at __________________________________.
I further give my permission for Mr./Mrs. ________________ to care for the children in
his/her home and to apply for, consent to, or otherwise obtain any medical treatment or any
economical, social, educational, or other services that the children may need.
(Sign in front of a Notary Public)

day of

________________________
Date

____________________________
Signature

________________________
Date

____________________________
Signature

Taken, subscribed and sworn to before the undersigned authority this
, 2_____.
My commission expires

.

______________________
Notary Public