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Polyamory for the Practical

A small stopgap on the custody issue.

Children and child custody is often an issue in a poly family.   In our own case, both of the children were born to legal marriages, so are legally in the custody of their biological parents.   However, my son is often in the care of my wife for whatever reason.   Were he to have an accident, the fact that she has no legal rights with my son could make seeking care difficult.   Do remember that this is not a document that will decide custody, nor will it really protect you from outside attempts to gain custody.   We have these documents on file as just one more written expression of our wishes and preferences.   Do talk to a lawyer if you have questions of custody, wills and the like.   If you want a printable version of the form, look here .


We, the undersigned parents, ____________________ and _________________, of (add your street address here), (city), (state) (zip), hereby grant _______________ and _______________, of (add your street address here), (city), (state) (zip), the authority to take temporary care of the following child(ren): (Child(ren)'s Names).   This grant of temporary authority shall begin on (Date), and shall remain effective until terminated by the undersigned.

    The above named caretaker(s) shall have the power to:

  • seek appropriate medical treatment or attention on behalf of the child(ren) as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits
  • authorize medical treatment or medical procedures in an emergency situation
  • make appropriate decisions regarding clothing, bodily nourishment, and shelter
  • explain absences from school
  • sign release forms for sports
  • sign release forms for field trips

Dated: (Date)


(name of first parent)


(name of second parent)

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