La. Child. Code art. 1515

A. A petition for voluntary transfer of custody shall set forth specifically:

(1) The name and address of all parents and legal custodians.

(2) An affirmation that the parents are knowingly and voluntarily transferring custody.

(3) The full name and date of birth of the child whose custody is sought to be transferred.

(4) The factual basis for the transfer of custody.

(5) The nature, duration, and extent of the transfer of custody, including any terms and conditions.

(6) The name and address of the agency, institution, or individual to whom the child is sought to be transferred and the relationship, if any, to the child.

(7) Whether the Department of Children and Family Services has recommended a petition for voluntary transfer of custody be filed.

(8) Whether the child is an Indian child.

B. The form for the petition shall be as follows:

"PETITION FOR VOLUNTARY TRANSFER OF CUSTODY

The petition of_______ (all legal custodians of the child unless otherwise indicated in Paragraph III of the petition), domiciled in the parish of _______, respectfully represent(s):

I.

That petitioner(s) reside at the following address(es):

________________________________________________________________________

________________________________________________________________________

II.

That petitioner(s) is/are the parent(s) and legal custodian(s) of the minor child(ren), namely _______________________________, whose date of birth is ______________ (add same information for all children subject to the petition), as more fully appears from the attached certificate(s) of birth.

Is the child an Indian child?

____ ____

Yes No

III.

That there are no other legal custodians of the child(ren) OR that a legal custodian, namely _______________________, is unable to join in this petition for the following reasons:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

_______________________________________________________________________.

IV.

That petitioner(s) desire(s) to knowingly and voluntarily transfer custody of the above named children to ____________________________, which individual(s), institution or agency reside(s) at the following address:

________________________________________________________ and who have the following relationship with the children:

________________________________________________________________________

________________________________________________________________________.

V.

That petitioner(s) desire to transfer physical custody OR legal custody of the person of the children (indicate one) for the period of time ______________(specify intended duration) in accordance with the following terms and conditions ________________________________________________________________________

________________________________________________________________________

(may include provisions for support and/or visitation).

VI.

That petitioners desire this transfer of custody for the following reasons: ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

_________________________________________________________________________

________________________________________________________________________.

Has the Department of Children and Family Services recommended to you that this petition be filed?

________ _______

Yes No

If yes, state name of the Department of Children and Family Services worker making the recommendation and the reasons for the recommendation with particularity.

If the department has recommended that this petition be filed, you have a right to counsel. Have you consulted with an attorney?

________ _______

Yes No

VII.

That ________________________ has/have agreed to and does/do desire to accept custody of the child(ren) to the extent and under the terms and conditions stated in this petition, as more fully appears in the attached Affidavit of Acceptance.

WHEREFORE, petitioner(s) pray(s) that there be judgment herein transferring custody of the child(ren), _______________, _____________, ________________, ________________, to ________________________, to the extent and under the terms and conditions set forth in this petition.

________________________________

(Signature and address of Petitioner(s))

or counsel for Petitioner(s)

(If in proper person, petition should be signed in presence of a notary.)

SWORN TO AND SUBSCRIBED BEFORE ME ON THIS THE _____ DAY OF ___________________, 20 ___.

____________________________

NOTARY PUBLIC"

C. The petitioner shall inform the court if he subsequently discovers information indicating that the child is an Indian child.