A separate authorization agreement should be
prepared for each child.
This will not work if CPS have placed the child with someone. You need to hire a family law attorney with CPS cases if CPS is involved in your case. Look on www.avvo.com for a "CPS attorney" or look on this blog for my post on Harris County CPS attorneys that I know.
This form can be revoked by the parent at any time but if you have allowed the person to have the child in the home over 6 months -- then they then have legal standing to file a lawsuit against you and ask for permanent custody of the child. Then no policing agency (sheriff, constable or police) will remove the child from the non-parent's custody if a lawsuit is pending.
If you sign this, it means that you are voluntarily surrendering your child to a non-parent. This form can be used against you at a later date in order to ask a judge to ask for permanent custody of the child.
I do not recommend using this form unless you talk to a family law attorney in person to understand what problems could arise in the future.
USE AT YOUR OWN RISK!
This is not a court ordered legally binding document -- a court order must be signed by a Judge in order for it to be legally binding AND enforceable in the future on all parties.
This expires the moment the child turn 18 and becomes an adult in the State of Texas.
If you have a terminal illness, then going to court and asking the judge to order another conservator is a good idea. It is rarely done but the judges but I have done several when one parent was terminally ill and the other parent was absent. It involves some creative lawyering and I recommend that you hire an experienced family law attorney to guide you.
The other parent must be served. If you don't know where they are then it would be a publication lawsuit which is more costly and takes a lot longer. But it might be a way of solving your problem.
Authorization Agreement for Nonparent Relative
The parties to this
authorization agreement are—
Name of parent:
Address:
[Telephone number/Best way to
contact]:
If the other parent is participating add:
Name of parent:
Address:
[Telephone number/Best way to contact]:
Name of relative:
Relationship to child:
[grandparent/adult sibling/adult aunt/adult uncle]
Address:
[Telephone number/Best way to
contact]:
If more than one person will be given rights then add --
Name of relative:
Relationship to child: [grandparent/adult sibling/adult aunt/adult uncle]
Address:
[Telephone number/Best way to contact]:
THEN ADD WHAT IS APPLICABLE IN YOUR CASE:
The other parent of the child
[is deceased/has had [his/her] parental rights terminated].
(IDEALLY ATTACH COPY OF DEATH CERTIFICATE OR TERMINATION OF PARENTAL RIGHTS.)
OR
The other parent of the child
is not a party to this authorization agreement.
The following information is
known about the other parent:
Name:
Address:
[Telephone number/Best way to
contact]:
The child who is the subject of
this authorization agreement is—
(IDEALLY ATTACH A COPY OF THE CHILD'S BIRTH CERTIFICATE)
Name:
Date of birth:
Sex:
Last three numbers of Social
Security number:
Location of Birth:
The parent[s] authorize[s] the
relative to perform the following acts in regard to the child:
(select what the non-parent is allowed to do)
1. to authorize medical, dental,
psychological, or 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. AND/OR
2. to obtain and maintain health insurance coverage for the
child and automobile insurance coverage for the child, if appropriate; AND/OR
3. to enroll the child in a day-care program or preschool or in
a public or private primary or secondary school; AND/OR
4. to authorize the child to participate in age-appropriate
extracurricular, civic, social, or recreational activities, including athletic
activities; AND/OR
5. to authorize the child to obtain a learner’s permit,
driver’s license, or state-issued identification card; AND/OR
6. to authorize employment of the child; AND/OR
7. to apply for and receive public benefits on behalf of the
child.
The relative has been given
authorization to perform the functions listed above as a result of a voluntary
action of the parent[s], and the relative has voluntarily assumed the
responsibility of performing those functions.
Neither the parent[s] nor the
relative has knowledge that a parent, guardian, custodian, licensed
child-placing agency, or other authorized agency asserts any claim or authority
inconsistent with this authorization agreement with regard to actual physical
possession or care, custody, or control of the child.
INCLUDE:
To the best of the
[parent’s/parents’] and the relative’s knowledge, there is no court order or
pending suit affecting the parent-child relationship concerning the child;
there is no pending litigation in any court concerning custody, possession, or
placement of the child or access to or visitation with the child; and the court
does not have continuing jurisdiction concerning the child.
OR
The court with continuing
jurisdiction concerning the child is the [number] Court of [county] County, Texas. In cause number [number in
which order was issued or litigation is pending], that court has given written approval for the
execution of this authorization agreement.
OR
To the best of the
[parent’s/parents’] and the relative’s knowledge, there is no current, valid
authorization agreement regarding the child.
This authorization is made in
conformance with chapter 34 of the Texas Family Code.
The parent[s] and the relative
understand that each party to this authorization agreement is required by law
to immediately provide to each other party information regarding any change in
the party’s address or contact information.
The parent[s] state[s] that
this authorization agreement—
expires on the occurrence of
the following circumstances: [specify] [.]
OR
is valid until revoked[.]
OR
expires on [date]
[.]
and continues in effect after
the death or during the incapacity of the parent[s].
Warnings and Disclosures
The parties to this
authorization agreement acknowledge—
1. that this authorization agreement is an
important legal document;
2. that the parent[s] and the relative must read all of the
warnings and disclosures before signing this authorization agreement;
3. that the persons signing this authorization agreement are
not required to consult an attorney but are advised to do so;
4. that the parent’s rights as a parent may be adversely
affected by placing or leaving the parent’s child with another person;
5. that this authorization agreement does not confer on the
relative the rights of a managing or possessory conservator or legal guardian;
6. that 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 that at any time the parent may request
the return of the child;
7. that failure by the relative to return the child to the
parent immediately on request may have criminal and civil consequences;
8. that, under other applicable law, the relative may be liable
for certain expenses relating to the child in the relative’s care but that the
parent still retains the parental obligation to support the child;
9. that, in certain circumstances, this authorization agreement
may not be entered into without written permission of the court;
10. that this authorization agreement may be
terminated by certain court orders affecting the child;
11. that this authorization agreement does
not supersede, invalidate, or terminate any prior authorization agreement
regarding the child;
12. that this authorization agreement is void
if a prior authorization agreement regarding the child is in effect and has not
expired or been terminated;
13. that, except as provided by section
34.005(a–1) of the Texas Family Code, this authorization agreement is void
unless—
(a) the
parties mail a copy of the authorization agreement by certified mail, return
receipt requested, or international registered mail, return receipt requested,
as applicable, to a parent who was not a party to the authorization agreement,
if the parent is living and the parent’s parental rights have not been
terminated, not later than the tenth day after the date the authorization
agreement is signed, and
(b) if the
parties do not receive a response from the parent who is not a party to the
authorization agreement before the twentieth day after the date the copy of the
authorization agreement is mailed under paragraph (a) immediately above, the
parties mail a second copy of the authorization agreement by first-class mail
or international first-class mail, as applicable, to the parent not later than
the forty-fifth day after the date the authorization agreement is signed; and
14. that this authorization agreement does
not confer on a relative of the child the right to authorize the performance of
an abortion on the child or the administration of emergency contraception to
the child.
____________________________________
[Name
of parent]
SIGNED under oath before me on ______________________________ by _______________ [name of parent].
____________________________________
Notary Public, State of Texas
____________________________________
[Name of parent]
SIGNED under oath before me on ______________________________ by ________________ [name of parent].
____________________________________
Notary Public, State of Texas
_________________________________
[Name
of nonparent relative]
SIGNED under oath before me on ______________________________ by _________________ [name of nonparent relative].
____________________________________
Notary Public, State of Texas
_________________________________
[Name of nonparent relative]
SIGNED under oath before me on ______________________________ by __________________[name of nonparent relative].
____________________________________
Notary Public, State of Texas
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