WP E-Signature by Approve Me - Sign Documents Using WordPress -

Final step. Click on "Agree & Finish” to finish signing.

Document complete.

1 of 1 page

I am and I agree to be legally bound by this agreement and WP E-Signature Terms of Use.

Child's Name:

Date of Birth:

Parent / Legal Guardian:

Relationship to Child:

Custody Statement

I am the child's parent or legal guardian.

I have legal authority to consent to mental health services for this child.

If custody is shared, name of other parent/guardian:

Signature of Parent / Legal Guardian

You're done signing! Child Custody Attestation