Get DA 7666 2009-2023

SOLDIER S SIGNATURE STATE OF COUNTY OF Acknowledged before me this day of NOTARY PUBLIC My commission expires OTHER PARENT S SIGNATURE DA FORM 7666 SEP 2009 APD PE v1. PARENTAL CONSENT 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. PRINCIPAL PURPOSE To record the agreement of both parents with their child s custodial arrangement as documented in the Family Care Plan. ROUTINE USES None. PARENTAL CONSENT 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. PRINCIPAL PURPOSE To record the agreement of both parents with their child s custodial arrangement as documented in the Family Care Plan* ROUTINE USES None. DISCLOSURE Mandatory failure to maintain a Family Care Plan could subject you to separation administrative action or disciplinary action under the UCMJ* In accordance with this agreement the parties confirm the following stipulations of fact and terms of agreement a member of the United States Army hereinafter the Soldier and are the parents of born in hereinafter the child date of birth. The child currently resides primarily with at a* As a function of performing military duties the Soldier may have to perform temporary duty be deployed or otherwise not be available to care for the minor child. b. The Soldier has been notified that he or she is to be temporarily deployed* The time period of deployment has been estimated to be in length. As a matter of military necessity the minor child will not be able to reside with or exercise access to the Soldier during this time. Initial appropriate paragraph The parties agree that each has reviewed the attached Family Care Plan as set forth in Form DA 5305 which indicates that for the time period that the Soldier is absent is to serve as the minor child s temporary physical guardian* physical custody to the temporary guardian and effectuate this consent. By the signatures below each party indicates their consent to the arrangements outlined in the attached Family Care Plan and this agreement. Section 3013 Secretary of the Army Army Regulation 600-20 Army Command Policy. PRINCIPAL PURPOSE To record the agreement of both parents with their child s custodial arrangement as documented in the Family Care Plan* ROUTINE USES None. DISCLOSURE Mandatory failure to maintain a Family Care Plan could subject you to separation administrative action or disciplinary action under the UCMJ* In accordance with this agreement the parties confirm the following stipulations of fact and terms of agreement a member of the United States Army hereinafter the Soldier and are the parents of born in hereinafter the child date of birth. DISCLOSURE Mandatory failure to maintain a Family Care Plan could subject you to separation administrative action or disciplinary action under the UCMJ* In accordance with this agreement the parties confirm the following stipulations of fact and terms of agreement a member of the United States Army hereinafter the Soldier and are the parents of born in hereinafter the child date of birth. The child currently resides primarily with at a* As a function of performing military duties the Soldier may have to perform temporary duty be deployed or otherwise not be available to care for the minor child. .