Ask the court to witness your parental responsibility agreement
| Published date | 21 March 2018 |
| Subject Matter | Children Act forms |
Parental Responsibility Agreement
Section 4(1)(b) 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 Parental Responsibility Agreement regarding
the Child Full Name
Gender Date of birth Date of 18th birthday
Between
the Mother Name
Address
and the Father Name
Address
We declare that we are the mother and father of the above child and we agree that the child’s father shall have
parental responsibility for the child (in addition to the mother having parental responsibility).
Signed (Mother)
Date
Signed (Father)
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]
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(PRA1) (08.14) © Crown copyright 2014
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