Opening terms
This Temporary Caregiver Authorization is made on October 2, 2026 by [first authorizer], [capacity], of [address], together with [second authorizer], [capacity], of [address] (collectively, the “Authorizer”), concerning [child], born October 2, 2026 and ordinarily residing at [child's address] (the “Child”).
The Authorizer appoints [caregiver], born October 2, 2026, of [caregiver's address], the Child's [relationship], as the limited temporary “Caregiver” on the terms below. The Caregiver's contact is [contact].
Authority basis: joint parents. Supporting record: PSA civil-status records and current identity documents establishing the authorizers' relationship and authority. No controlling custody or protective order is known to the Authorizer.