Transcription of (name and relationship to the children)
1 temporary custody AGREEMENTI, _____, 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 _____ _____ currently resides at further give my permission for _____ to care for the children inhis/her home and to apply for, consent to, or otherwise obtain any medical treatment or anyeconomical, social, educational, or other services that the children may need.(Sign in front of a Notary Public)_____DateSignature_____Date SignatureTaken, subscribed and sworn to before the undersigned authority this day of , commission expires.
2 _____Notary Public
