(To be filled out and signed by a single woman who is releasing the father of her child from his minimum responsibility as outlined in the Sex and Affection Rules, L. and M. starting. This form should also be signed by at least one of the Home's officers as a witness. Copies of this form should be given to the mother, the father, and sent to the Continental Office.)

Date: ___/___/____

Bible name of mother: _____________________

Bible name of father:_____________________
I _________________________________, mother of ______________________, hereby release ____________________________, father of ________________________ , from the remainder of his period of minimum responsibility to care for me and ______________ , for the following reason:
This release is official as of ___/___/____.

Signature of mother __________________________

(The following to be filled in by at least one Home teamwork member.)

I affirm that _____________________ , mother of _____________________________ , has officially released
_______________________________ , from his minimum responsibility to her and ___________________.

Signature of Home officer: ___________________________________

Signature of Home officer (optional): ___________________________________

Signature of Home officer (optional): ___________________________________

Copyright (c) 1998 by The Family