Authorization Agreement for Nonparent Adult Caregiver - Texas

AUTHORIZATION AGREEMENT FOR NONPARENT ADULT CAREGIVER

This agreement is made voluntarily under Texas Family Code chapter 34 by the parent(s) identified below and the adult caregiver. Only one authorization agreement may be in effect for this child at a time. The parties must sign and swear to this agreement before a notary public.

1. Child and parties

Child's full name: [________________________________]

Child's date of birth: [__/__/____]

Caregiver's relationship to child: [________________________________]

Other parent's name and last known mailing address, if that parent is not signing: [________________________________]

2. Authority accepted by the caregiver

The signing parent(s) authorize the caregiver, who voluntarily accepts responsibility, to perform the following acts for this child to the extent permitted by Texas Family Code § 34.002(a) and other applicable eligibility rules:

1. Authorize medical, dental, psychological, or surgical treatment and immunization, including treatment-related information releases required by law.
2. Obtain and maintain health insurance and, if appropriate, automobile insurance for the child.
3. Enroll the child in day care, preschool, or a public or private elementary or secondary school.
4. Authorize age-appropriate extracurricular, civic, social, recreational, and athletic activities.
5. Authorize the child to obtain a learner's permit, driver's license, or state identification card, and authorize employment.
6. Apply for and receive public benefits on the child's behalf.
7. Obtain state-issued identification documents for the child, including a birth certificate, and federally issued identification documents, including a Social Security card, only to the extent federal law allows.

Limits agreed by the parties, if any: [________________________________]

This agreement does not authorize the caregiver to consent to an abortion or the administration of emergency contraception for the child. It does not override eligibility requirements under other laws.

3. Court matters and existing agreement

The parent(s) and caregiver state, to the best of their knowledge, that no parent, guardian, custodian, licensed child-placing agency, or other authorized agency asserts a claim or authority inconsistent with this agreement concerning possession, care, custody, or control of the child.

The parent(s) and caregiver also state, to the best of their knowledge, that no current valid authorization agreement concerning this child is in effect, and select the applicable court-matter statement:

☐ There is no court order or pending suit affecting the parent-child relationship, no pending custody, possession, placement, access, or visitation litigation, and no court with continuing jurisdiction concerning this child.

☐ A relevant order, suit, or continuing jurisdiction exists. The written approval of the appropriate court is attached before the parties sign this agreement.

County of approving court: [________________________________]

Court number: [________________________________]

Cause number: [________________________________]

An agreement executed without a required written court order is void.

4. Term — select one

☐ This agreement runs for six months from the date the parties sign it and renews automatically for six-month terms unless it ends under Texas Family Code § 34.008.

☐ This agreement ends on [__/__/____], a specific date earlier than six months after the parties sign it.

Before that date, the agreement may end under § 34.008 by a covered court order or a party's written revocation with the required notices and filings. A court entering a covered order may permit the agreement to continue in writing.

5. Required warnings and disclosures — read before signing

1. This is an important legal document. Read all warnings and disclosures before signing. You are not required to consult an attorney, but you are advised to do so.
2. A parent's rights may be adversely affected by placing or leaving the child with another person. This agreement does not make the caregiver a managing or possessory conservator or legal guardian.
3. A signing parent may terminate this agreement and demand the child's return at any time. Failure by the caregiver to return the child immediately on request may have criminal and civil consequences.
4. Other law may make the caregiver liable for certain expenses for a child in the caregiver's care. The parent remains obligated to support the child.
5. A court order or pending case may require written court permission before the parties enter this agreement. Later court orders described in § 34.008 may end it unless the court permits continuation.
6. This agreement does not supersede, invalidate, or terminate a prior agreement for the child. It is void if a prior agreement is still in effect when this one is signed.
7. If both parents do not sign and the other parent is living with parental rights intact, the parties must, unless the narrow § 34.005(a-2) exception applies, mail that parent two copies within ten days after signing: one by certified mail with return receipt (or international registered mail with return receipt) and one by first-class mail (or international first-class mail). Failure to comply makes the agreement void.
8. This agreement does not authorize the caregiver to consent to an abortion or the administration of emergency contraception for the child.
9. Each party must immediately tell every other party about a change in that party's address or contact information. Failure to do so makes the agreement voidable by another party.

6. Non-signing parent notice record

☐ Both parents sign this agreement; no notice to a non-signing parent is needed.

☐ One parent signs; the other parent is deceased or that parent's parental rights have been terminated. Basis: [________________________________].

☐ One parent signs; the other parent is living with parental rights intact. The parties will send the two required mailings within ten days after signing and keep proof of delivery attempts.

☐ The parties rely on the narrow § 34.005(a-2) exception. The non-signing parent has no court-ordered possession or access and a qualifying protective order or violent-offense conviction documents family violence or assault. Identify and retain the records: [________________________________].

Date certified or international registered copy mailed: [__/__/____]

Return-receipt or registration number: [________________________________]

Date first-class or international first-class copy mailed: [__/__/____]

7. Revocation and return of child

A party revoking this agreement in writing must give every party written notice; file the revocation with the clerk of the county where the child now lives, where the child lived when the agreement was signed, or where the caregiver lives; and file it with the clerk of every applicable court listed in Texas Family Code § 34.008(c)(3). Either signing parent may revoke without the other parent's consent. The caregiver shall return the child immediately when a parent demands the child's return.

8. Signatures and sworn notarial certificate

By signing, each parent and the caregiver confirms that the statements made by that person are true to the best of that person's knowledge, this agreement conforms to Texas Family Code chapter 34, and the caregiver voluntarily accepts the listed duties.

Parent signature: ____________________________________ Date: [__/__/____]

Parent printed name: [________________________________]

Second parent signature, if signing: ____________________________________ Date: [__/__/____]

Second parent printed name: [________________________________]

Adult caregiver signature: ____________________________________ Date: [__/__/____]

Adult caregiver printed name: [________________________________]

State of Texas

County of [________________________________]

Subscribed and sworn to before me on [__/__/____] by [PARENT NAME(S)] and [ADULT CAREGIVER NAME].

Notary public signature: ____________________________________

Notary printed name: [________________________________]

Commission expiration: [__/__/____]

Notarial seal: [________________________________]

Official law: Texas Family Code chapter 34.