2024-25 Child Custody Agreement

1

Child' Name* This field is required.

First Name

Last Name

2

Today's Date* This field is required.

3

Are there any Court Orders, Decrees or Agreements in regard to the child’s legal custody or physical possession?* This field is required.

YESNO

4

Name of Custodial Parent #1:* This field is required.

5

Name of Custodial Parent #2:* This field is required.

6

Please indicate which parent has legal custody:* This field is required.

Custodial Parent #1

Custodial Parent #2

Joint custody, both parents

Other

7

Please describe the specific custody agreement currently in place:* This field is required.

8

Please indicate the physical possession agreements of the child, i.e., when the child is legally permitted to be with each parent:
Custodial Parent #1:    First Name *     Last Name *
Physical possession agreement:    *
Custodial Parent #2:    First Name *     Last Name *
Physical possession agreement:    *
Other (please specify):    *

9

Please provide all Court Orders, Decrees or Agreements in regard to the child’s legal custody and/or physical possession and any other information that the JCDSRI should be aware of pertaining to the custody and/or physical possession of the child, as well as any educational mandates that JCDSRI needs to be aware. IF CHANGES OCCUR, A COPY OF ALL LEGAL CHANGES TO THE CUSTODY/PHYSICAL POSSESSION ARRANGEMENTS MUST BE GIVEN TO JCDSRI IMMEDIATELY.* This field is required.

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10

Custodial Parent 1 Signature:* This field is required.

11

Date* This field is required.

Date

12

Custodial Parent 2 Signature:* This field is required.

Clear

13

Date* This field is required.

Date