Fillable Da Form 7666 - Apd - Army printable pdf download

Da Form 7666 - Apd - Army

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PARENTAL CONSENT

For use of this form, see AR 600-20; the proponent agency is DCS, G-1.

PRIVACY ACT STATEMENT

10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.

AUTHORITY:

To record the agreement of both parents with their child's custodial arrangement as documented in the Family

PRINCIPAL PURPOSE:

Care Plan.

None.

ROUTINE USES:

DISCLOSURE:

Mandatory; failure to maintain a Family Care Plan could subject you to separation, administrative action, or

disciplinary action under the UCMJ.

In accordance with this agreement the parties confirm the following stipulations of fact and terms of agreement:

are the parents of

a member of the United States Army, (hereinafter "the Soldier"), and

(hereinafter "the child"), date of birth

, born in

The child currently resides primarily with

As a function of performing military duties, the Soldier may have to perform temporary duty, be deployed, or otherwise not be available to care

for the minor child.

The Soldier has been notified that he or she is to be temporarily deployed. The time period of deployment has been estimated to be

in length. As a matter of military necessity, the minor child will not be able to reside with, or exercise access to the

Soldier during this time. (Initial appropriate paragraph)

The parties agree that each has reviewed the attached Family Care Plan as set forth in Form DA 5305, which indicates that for the time period that the

Soldier is absent,

is to serve as the minor child's temporary physical guardian.

The parties agree that during this period the minor child will reside at

The parties agree that each will cooperate with the execution of any additional documentation as may be necessary to facilitate the designation of

physical custody to the temporary guardian and effectuate this consent.

By the signatures below, each party indicates their consent to the arrangements outlined in the attached Family Care Plan and this agreement.

(SOLDIER'S SIGNATURE)

STATE OF

COUNTY OF

Acknowledged before me this

day of

(NOTARY PUBLIC)