This form can be used to handover the custody of the Child to the grandparents by the father. This form may be applicable if the custody of the child is with the Mother and she is seriously ill and may not recover.
Text Version of this Form
Agreement for Custody of Child
____________________ (FATHER) is the father of the child _______________________ (CHILD) born on the _________ day of ______________, 20___. CHILD has for most of the time resided with her [his] grandparents. ______________________(MOTHER) the mother of CHILD, is now seriously ill and may not recover and it has been agreed that in the event of death the grandparents shall assume the care and maintenance of CHILD and take over custody, to which FATHER has agreed.
In consideration of the premises and one dollar paid by grandparents to FATHER, FATHER grants and assigns to grandparents all rights to the possession, custody, control, and care of CHILD and all the right and advantage to be derived from the custody and possession of the child until she [he] attains majority or marries under that age.
FATHER appoints grandparents to be the guardians of the personal estate of CHILD until she [he] shall attain the age of eighteen years or marries, and agrees not to revoke this appointment or appoint any other person to be the guardian of the child, and grandparents will adopt the child and covenant and agree with FATHER that until such time as the child attains the age of eighteen years or marries they will maintain, lodge, clothe, and educate CHILD to the same extent and in the same manner as if CHILD were their own lawful child, and will at their own expense provide the child with all necessaries, and will pay and discharge all debts and liabilities which the child may incur for necessaries, and will indemnify FATHER against all actions, claims, and demands. Grandparents agree that FATHER shall have access to the child at all reasonable times.
FATHER agrees not to try to use these visits for the purpose of influencing the child to leave grandparents. It is further covenanted and agreed that FATHER will not nor shall any person transfer in any way the rights of FATHER in the control and custody of the child.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written.