Child Raise Request Form

Child Raise Request Form

Requesting Party (Parent/Guardian):   Contact Address:

Recipient Party (Co-Parent / Care Provider):   Contact Address:

Child Name:   Date of Birth:   Primary Residence:

Recitals

WHEREAS, Requesting Party is a parent or legal guardian of the Child identified above and seeks a formal, written agreement setting forth specified child-raising responsibilities and supports to ensure the Child's welfare, safety, education, and medical care; and

WHEREAS, Recipient Party has the ability and willingness to assume certain day-to-day responsibilities and obligations described in this agreement, subject to the terms and conditions set forth below; and

WHEREAS, the Parties desire to reduce to writing their mutual understanding regarding responsibilities, compensation (if any), and decision-making authority to avoid misunderstanding and to promote the Child's best interests.

Scope of Work

The Recipient Party shall perform the child-raising duties described in this section. The Parties agree the Recipient Party's responsibilities will include, at minimum, the items below and any additional tasks expressly incorporated in the detailed scope textarea:

Standard weekday care hours:   Weekend care hours (if applicable):

Permissions and Authorizations

The Requesting Party grants the following permissions to the Recipient Party for the duration of this agreement (check all that apply):

 Authorize routine medical and emergency treatment as reasonably necessary for the Child's health and safety.
 Make day-to-day educational and school-related decisions (attendance, extracurricular activities) in consultation with Requesting Party when practicable.
 Transport the Child locally and authorize short trips (less than 24 hours local travel) consistent with safety requirements.

Payment Terms

Compensation for services and any agreed-upon reimbursements shall be governed by this section. If no monetary compensation is due, enter "N/A" in the Amount field.

Payments not made within the agreed period shall accrue the late fee described above and the Recipient Party may suspend non-emergency services after providing written notice in accordance with the Termination provisions below.

Term and Termination

This Agreement commences on Start Date and continues until End Date, unless earlier terminated in accordance with this section.

Termination for cause (including material breach, failure to maintain required clearances, or conduct endangering the Child) is permitted with immediate effect upon written notice. Upon termination, any unpaid, earned payments shall be payable within thirty (30) days.

Confidentiality

The Parties acknowledge that certain information relating to the Child and the family is confidential. Each Party shall maintain confidentiality of medical records, educational records, contact information, and any sensitive personal information. Confidential information shall not be disclosed except (a) to comply with mandatory reporting obligations, (b) with prior written consent of the other Party, or (c) as required by lawful process. This obligation survives termination of this Agreement.

Representations, Warranties, and Indemnification

Each Party represents and warrants that they have authority to enter into this Agreement, that the information provided herein is true and accurate to the best of their knowledge, and that they will comply with all applicable laws, licensing, and mandatory reporting requirements. The Requesting Party agrees to indemnify and hold harmless the Recipient Party from claims arising from reliance on representations made by the Requesting Party, except to the extent caused by the Recipient Party's gross negligence or willful misconduct.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles.

Entire Agreement

This document constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior agreements, understandings, negotiations, and discussions, whether oral or written. Any modifications must be made in writing and signed by both Parties.

Certifications

By signing below, each Party certifies under penalty of perjury that the information provided in this form is true and correct, that they have the legal authority to enter this Agreement, and that they understand their rights and obligations as set forth herein.

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