Free Temporary Custody Letter [Sample]

Learn how to write a temporary custody letter. Use our sample temporary custody letter as a template for your custody letter.

Temporary Custody Letter sample

John and Jane Smith
123 North Avenue
Belmont, Virginia 89452

June 06, 2022

Jack and Mary Johnson
789 Lyndon Road
Belmont, Virginia 89452

RE: Temporary Custody of Child, Samantha Smith

John and Jane Smith give Jack and Mary Johnson temporary custody of their minor daughter, Samantha Smith from June 18, 2020 to June 25, 2022. 

This official temporary custody letter will act as a legal and binding document that will enable them to seek medical treatment on behalf of Samantha and to make any decisions concerning her needs for the specified period.

John and Jane Smith intend to travel to New York City on business concerning the dates previously stated.

Therefore, in their absence they will be unable to oversee the needs of their daughter Samantha or provide her medical treatment should she need it during the specified period of time.

They are therefore entrusting their daughter’s care to Jack and Mary Johnson and giving them temporary custody to make any important decisions regarding their daughter’s care. The address of the hotel the Smith’s will be staying at is:

Hilton Regency
787 Spartan Lane
New York, New York 10014
(555) 676-9023

Samantha Smith’s doctor is Dr. Deetz located at Dixon Medical Center in Belmont, Virginia. Their phone number is (353) 458-9832. Samantha’s dentist is Dr. Vogel at Vogel Dentistry.

Their office number is (555) 458-7622. You can find a copy of this document at either location. John and Jane Smith can be contacted at anytime on their cell phone at (555) 458-4433.


(sign your name here)
John and Jane Smith

Interesting finds