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PART II - DESIGNATION OF GUARDIANS/ESCORTS I We have designated the following temporary guardian to care for my our family member s until responsibility is transferred to escort or principal long-term guardian. TYPED OR PRINTED NAME TELEPHONE NUMBER Include Area Code COMPLETE ADDRESS Including Street Apartment Number P. O. Box Number Rural Route Number City State and ZIP 4 where applicable 2b. DA FORM 5305 DEC 2005 2a. E- MAIL ADDRESS DA FORM 5305-R APR 1999 IS OBSOLETE APD V1. O. Box Number Rural Route Number City State and ZIP 4 where applicable 2b. DA FORM 5305 DEC 2005 2a. E- MAIL ADDRESS DA FORM 5305-R APR 1999 IS OBSOLETE APD V1. 00 reside in the continental United States or United States territories. applies only to persons assigned OCONUS PART III - DUAL MILITARY COUPLES ONLY MILITARY SPOUSE AND COMMANDER CERTIFICATION Spouse We have made arrangements and will maintain arrangements for the care of our family member s in all circumstances required by our commitment to the military and our family. FAMILY CARE PLAN For use of this form see AR 600-20 the proponent agency is DCS G-1. PRIVACY ACT STATEMENT AUTHORITY 10 U*S*C. Section 3013 Secretary of the Army Army Regulation 600-20 Army Command Policy and E*O. 9397 SSN PRINCIPAL PURPOSE To emphasize to soldiers the significance of their responsibilities to the military service and their family members while performing required military duties. ROUTINE USES None DISCLOSURE Mandatory Failure to maintain a Family Care Plan could subject the soldier to separation administrative action or disciplinary action under the UCMJ* PART I - SOLDIER S FAMILY CARE A. date and fully understand the policy on family member I was counseled on care responsibilities. I understand that I must arrange for care of my family members remain available for deployment and training and report for duty as required without interference of responsibility for family members. I assume responsibility for all obligations for such things as child care food adequate housing transportation and emergency needs of my family members regardless of age. B. I have made and will maintain arrangements for the care of my family members during all the following 11. Deployment 6. Temporary Duty 1. Duty 12. Other Military Duty 7. Unit Training Assembly 2. Exercises/field duty 13. Emergencies 8. Active Duty Training 3. Permanent Change of Station 14. Leave/non-duty Time 9. Unaccompanied Tours 4. Alerts 10. Mobilization 5. Annual Training C. INITIALS I understand the importance of ensuring the proper care for my family members and ensuring my own readiness and deployability as well* I further understand that in light of the critical nature of both these requirements Failure to make and maintain adequate family member care arrangements in accordance with the Army s policy is grounds for disciplinary action or separation* Nonavailability for worldwide assignment and/or unit deployment may lead to my separation from the Army. If arrangements for the care of my family members fail to work I am not automatically excused from prescribed duties unit deployment or reassignment.

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