(a) The authorization agreement must contain:
(1) the following information from the adult caregiver:
(A) the name and signature of the adult caregiver;
(B) the adult caregiver’s relationship to the child; and
(C) the adult caregiver’s current physical address and telephone number or the best way to contact the adult caregiver;
(2) the following information from the parent:
(A) the name and signature of the parent; and
(B) the parent’s current address and telephone number or the best way to contact the parent;
(3) the information in Subdivision (2) with respect to the other parent, if applicable;
(4) a statement that the adult caregiver has been given authorization to perform the functions listed in § 34.002(a) as a result of a voluntary action of the parent and that the adult caregiver has voluntarily assumed the responsibility of performing those functions;
(5) statements that neither the parent nor the adult caregiver has knowledge that a parent, guardian, custodian, licensed child-placing agency, or other authorized agency asserts any claim or authority inconsistent with the authorization agreement under this chapter with regard to actual physical possession or care, custody, or control of the child;
(6) statements that:
(A) to the best of the parent’s and adult caregiver’s knowledge:
(i) there is no court order or pending suit affecting the parent-child relationship concerning the child;
(ii) there is no pending litigation in any court concerning:
(a) custody, possession, or placement of the child; or
(b) access to or visitation with the child; and
(iii) a court does not have continuing jurisdiction concerning the child; or
(B) the court with continuing jurisdiction concerning the child has given written approval for the execution of the authorization agreement accompanied by the following information:
(i) the county in which the court is located;
(ii) the number of the court; and
(iii) the cause number in which the order was issued or the litigation is pending;
(7) a statement that to the best of the parent’s and adult caregiver’s knowledge there is no current, valid authorization agreement regarding the child;
(8) a statement that the authorization is made in conformance with this chapter;
(9) a statement that the parent and the adult caregiver understand that each party to the authorization agreement is required by law to immediately provide to each other party information regarding any change in the party’s address or contact information;
(10) a statement by the parent that:
(A) indicates the authorization agreement is for a term of:
(i) six months from the date the parties enter into the agreement, which renews automatically for six-month terms unless the agreement is terminated as provided by § 34.008; or
(ii) the time provided in the agreement with a specific expiration date earlier than six months after the date the parties enter into the agreement; and
(B) identifies the circumstances under which the authorization agreement may be:
(i) terminated as provided by § 34.008 before the term of the agreement expires; or
(ii) continued beyond the term of the agreement by a court as provided by § 34.008(b); and
(11) space for the signature and seal of a notary public.
(b) The authorization agreement must contain the following warnings and disclosures:
(1) that the authorization agreement is an important legal document;
(2) that the parent and the adult caregiver must read all of the warnings and disclosures before signing the authorization agreement;
(3) that the persons signing the authorization agreement are not required to consult an attorney but are advised to do so;
(4) that the parent’s rights as a parent may be adversely affected by placing or leaving the parent’s child with another person;
(5) that the authorization agreement does not confer on the adult caregiver the rights of a managing or possessory conservator or legal guardian;
(6) that a parent who is a party to the authorization agreement may terminate the authorization agreement and resume custody, possession, care, and control of the child on demand and that at any time the parent may request the return of the child;
(7) that failure by the adult caregiver to return the child to the parent immediately on request may have criminal and civil consequences;
(8) that, under other applicable law, the adult caregiver may be liable for certain expenses relating to the child in the adult caregiver’s care but that the parent still retains the parental obligation to support the child;
(9) that, in certain circumstances, the authorization agreement may not be entered into without written permission of the court;
(10) that the authorization agreement may be terminated by certain court orders affecting the child;
(11) that the authorization agreement does not supersede, invalidate, or terminate any prior authorization agreement regarding the child;
(12) that the authorization agreement is void if a prior authorization agreement regarding the child is in effect and has not expired or been terminated;
(13) that, except as provided by § 34.005(a-2), the authorization agreement is void unless not later than the 10th day after the date the authorization agreement is signed, the parties mail to a parent who was not a party to the authorization agreement at the parent’s last known address, if the parent is living and the parent’s parental rights have not been terminated:
(A) one copy of the authorization agreement by certified mail, return receipt requested, or international registered mail, return receipt requested, as applicable; and
(B) one copy of the authorization agreement by first class mail or international first class mail, as applicable; and
(14) that the authorization agreement does not confer on an adult caregiver the right to authorize the performance of an abortion on the child or the administration of emergency contraception to the child.