Authorization Agreement For Nonparent Relative Or Voluntary Caregiver - Texas

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Note: Also known as Form 2298
AUTHORIZATION AGREEMENT
August 2011
Page 1 of 4
FOR NONPARENT RELATIVE OR
VOLUNTARY CAREGIVER
This authorization agreement is made in conformance with Chapter 34 of the Texas
Family Code concerning the following Child:
Child's
Full
Name:
Date of Birth:
Parent completing this form:
Full Name:
Physical
Address:
Telephone
Number:
Other
contact
information:
Child's other parent:
Full Name:
Physical
Address:
Telephone
Number:
Other
contact
information:
Parent voluntarily authorizes the following relative or Parental Child Safety Placement
voluntary caregiver to make certain decisions regarding the child, as listed on the next
page of this authorization agreement.
Name:
Relationship to Child (check one):
Child's Grandparent
Child's Adult Sibling
Child's Aunt or Uncle
Parental Child Safety Placement Voluntary Caregive
r in accordance with Child Protective Services
Physical
Address:
Telephone
Number:
Other
contact
information:
PARENT AND RELATIVE OR VOLUNTARY CAREGIVER UNDERSTAND THAT THEY ARE
REQUIRED BY LAW TO IMMEDIATELY PROVIDE EACH OTHER WITH INFORMATION
REGARDING ANY CHANGE IN THE OTHER PARTY'S ADDRESS OR CONTACT
INFORMATION.

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