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The completion of this form is needed if your child is living with one parent, or is shared jointly between both parents living in two different households.

Child NamePlease enter your child's full name

Name of Custodial ParentParent with whom the child resides

Custodial Parent Street Address

Custodial Parent City

Custodial Parent Zip Code

Custodial Parent Phone Number

Custodial Parent Email

If custody is joint, name of who joint custody is shared with:

Name of Non-Custodial Parent

Non-Custodial Parent Street AddressIf known

Non-Custodial Parent City

Non-Custodial Parent Zip Code

Non-Custodial Parent Phone Number

Non-Custodial Parent Email

Do you as the custodial or joint custodial parent have legal custody through a court order?

YesNo

If there is a court order, does it permit the child to be released to the non-custodial parent?

YesNo

Does the court order allow the non-custodial parent to access school records?

YesNo

Please provide any additional information regarding custody.

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Please provide a copy of any court order or custody agreement that may exist.You may upload multiple files.

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Signature

Parent/Guardian Signature

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Child Custody Form

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