This resource has the form that you can use to temporarily appoint someone to take care of your children, called a Designation of Person in Parental Relationship.

Things you should know before starting


You cannot use this form if:

  • There is a Court Order in place now that would stop you from choosing (or “designating”) another person to serve in a parental relationship, from any Court, including outside of New York.

  • There is a Court Order that now requires that both parents agree on education or health decisions for the children named in the form.

If you have a Court Order that requires both parents to agree on education or health decisions for the children, you can use the OCFS-4940 form that has a space for the other parent to give consent to your decision in Paragraph 8.

Signing this form

If you want the person to care for your children for longer than thirty days, both you and that person will need to sign the form in front of a notary. During the pandemic, the governor has authorized e-notarization, so that you don't have to go to a notary in-person. Click here for more instructions on how to connect with a notary virtually.

What to do next

You can print the form and fill it out by hand or fill out the form on your computer and then click print to get a typed version.

If you choose to fill it out on the computer and then print the typed version, do not type in initials or signatures. 

Go back to the guide

This resource is part of a longer guide on legal planning documents. If you just landed here, click here to go back to the guide to learn more about power of attorney and other legal planning documents you may want to prepare.


Download the form instructions (click the PDF icon)


Download the form (click the PDF icon)


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Last Reviewed: August 4, 2020