Ask the court to witness your step-parent parental responsibility agreement
| Published date | 21 March 2018 |
Step-Parent Parental
Responsibility Agreement
Section 4A(1)(a) Children Act 1989
Keep this form in a safe place
Date recorded at The Central Family
Court:
Read the notes on the other side before you make this agreement.
This is a Step-Parent Parental Responsibility Agreement regarding
the Child Full Name
Gender
Date of birth Date of 18th birthday
Between
Parent A Name
Address
and
*the other parent
(with parental
responsibility)
*If there is only
one parent
with parental
responsibility,
please delete
this section.
Name
Address
and
the step-parent Name
Address
We declare
that
we are the parents and step-parent of the above child and we agree that the above mentioned step-parent
shall have parental responsibility for the child (in addition to those already having parental responsibility).
Signed (Parent A)
Date
Certicate
of witness
The following evidence of
identity was produced by the
person signing above:
Signed in the presence of:
Name of Witness
Address
Signature of Witness
[A Justice of the Peace]
[Justices’ Clerk] [An assistant
to a justices' clerk] [An Ofcer
of the Court authorised by the
judge to administer oaths]
*Signed (Other Parent)
Date
The following evidence of
identity was produced by the
person signing above:
Signed in the presence of:
Name of Witness
Address
Signature of Witness
[A Justice of the Peace]
[Justices’ Clerk] [An assistant
to a justices' clerk] [An Ofcer
of the Court authorised by the
judge to administer oaths]
Signed (Step-Parent)
Date
The following evidence of
identity was produced by the
person signing above:
Signed in the presence of:
Name of Witness
Address
Signature of Witness
[A Justice of the Peace]
[Justices’ Clerk] [An assistant
to a justices' clerk] [An Ofcer
of the Court authorised by the
judge to administer oaths]
C(PRA2) (08.14) © Crown copyright 2014
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