
______________________________
______________________________
H.B. No. 804
gives me the right to enroll the minor child in the local education
agency serving the area where I reside.
(____) I understand that this document does not provide me
with legal custody of the minor child.
(____) I understand that, prior to enrollment, the local
education agency may require documentation of the minor child's
residence with a caregiver and/or documentation or other
verification of the validity of the stated hardship.
(____) I understand that, except to the extent limited by
federal law, I shall be assigned the rights, duties, and
responsibilities that would otherwise be assigned to the parent,
legal guardian, or legal custodian of the minor child.
(____) I understand that if the minor child ceases to reside
with me, I am required by law to notify any person, school, or
health care provider to whom I have given this document.
I/We declare under penalty of perjury under the laws of the
State of Texas that the foregoing is true and correct.
Signed this ___ day of __________, 20__.
Mother/Legal Guardian
The Mother/Legal Guardian, ______________________, personally
appeared before me this _____ day of ____________, 20__.
Notary Public in and for the State of Texas
My commission expires: ___________________
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