CUSTODY AGREEMENT AND PROMISE TO ADOPT
Agreement made on ____________________ (month &
day), ________ (year), between _________________________, the
______________________ (mother or father) of _________________________________
(name of child), of ____________
(address), here referred to as parent, and _____________________ and
____________________, husband and wife, of
____________________________________________________ (address), here referred
to as custodians, and subject to the approval of ________________________
(indicate appropriate governmental agency).
Parent, at the request of custodians, has placed in
the care, custody, and control of custodians, at their home at
_______________________________________ (address), for a probationary period of
_______, the child, _______________________________, who was born
______________________ (month & day), _________ (year), and who is under
the care, custody, and control of parent.
Custodians agree as follows:
To receive the child into their home for a trial
period of _________________________.
To treat the child as a member of their family and
to give _____ (him or her) proper care, and to love, cherish, nurture, and
educate ______ (him or her) in a suitable manner, as they would be required to do
if _________ (he or she) were their own child.
To notify parent promptly of any change of their
address, and in no case leave with or surrender the child to a third party, or
remove ____________ (him or her) from the State of _______________ for a period
of more than ______ (___) days, without the prior written consent of parent.
Parent shall have, at all reasonable times, access
to the child. Custodians shall
relinquish and surrender the child, and release all custody of and right to the
child, to parent whenever in the honest opinion of parent such relinquishment,
surrender, and release is in the best interest of the child.
Custodians reserve the right to return the child to
parent at any time during the probationary period whenever, in the honest opinion
of custodians, such return would be in the best interest of the child.
Custodians shall at the expiration of the
probationary period, and within ___________ (length of time) thereafter, if the
child is then in their custody and they agree that such is in the best interest
of all parties involved, commence adoption proceedings to effect the legal
adoption of the child. Custodians shall
pay all costs incident to such proceedings.
In witness whereof, the parties hereto have signed
this agreement at _______________ _______________ (designate place of
execution) the day and year first above written.