Louisiana Provisional Custody by Mandate Form: Where to Find It and How to Fill It Out

You have decided that a Provisional Custody by Mandate is the right tool for your situation. Now you need the actual form — and more importantly, you need to fill it out and execute it correctly so schools and doctors will accept it.

Where to Get the Form

The statutory form is codified at La. R.S. 9:954. You can find it at:

• LouisianaLawHelp.org — free downloadable PDF
• Louisiana Legal Navigator — searchable legal information portal
• Parish Clerk of Court websites — some parishes post the form in their family law or self-help sections
• LegalTemplates.net — offers a fillable version, though it requires a subscription

The form itself is free under state law. You do not need to pay a document preparation service to access it, though the bare form provides no guidance on execution or what to do afterwards.

What the Form Contains

The La. R.S. 9:954 form identifies:

• The delegating parent(s) — full legal names, addresses, and relationship to the child
• The mandatary (you) — the person receiving temporary custody authority
• The child — full name, date of birth
• The scope of authority — what decisions the mandatary is authorized to make (education, medical care, daily activities)
• The duration — a specific end date, which cannot exceed one year from execution
• Signature blocks — for the parent(s), the mandatary, two witnesses, and the notary public

Filling It Out: Step by Step

1. Enter all names exactly as they appear on government ID. Nicknames or abbreviated names create problems when a school registrar compares the mandate to a birth certificate.

2. Specify the child's full legal name and date of birth. If you are caring for multiple children from the same parent, each child should be named individually. Some practitioners execute one mandate per child for clarity; others list all children on a single instrument. Either approach is legally valid, but separate documents reduce confusion at school offices that file by student.

3. State the authority granted. The statutory form includes standard language covering education, medical care, and daily activities. If the child has specific medical needs — ongoing prescriptions, scheduled surgeries, behavioral health treatment — add explicit language authorizing those decisions. Vague authority invites pushback from cautious providers.

4. Set the end date. Choose a date no more than one year from the execution date. If you write a shorter period, the mandate expires at that earlier date. There is no automatic extension.

5. Leave each signature line blank until that signer is before the notary. Do not pre-sign. Each execution must be before a notary or other authorized officer and two witnesses, but La. Civ. Code art. 1833(B) does not require all signatures to be collected at the same time or place.

Execution Requirements That Trip People Up

The mandate must be executed as an "authentic act" under Louisiana law. That means:

• Each signer must execute the act before a notary public or another officer authorized to perform that function and in the presence of two witnesses
• Each party, witness, and notary must sign the act
• Signatures may be collected at different times or places and need not be before the same notary or witnesses (La. Civ. Code art. 1833(B))

A mandate signed without two witnesses may fail to satisfy the authentic-act requirement and may be rejected by schools or medical offices.

Where to Find Free or Low-Cost Notary Services

• Banks and credit unions — many offer free notarization for account holders
• Parish Clerk of Court offices — some provide notary services during business hours
• UPS Store locations — typically charge $5–$15 per signature
• Mobile notary services — useful if the parent is homebound or incarcerated, though they charge travel fees
• Legal aid offices — Southeast Louisiana Legal Services (SLLS), Acadiana Legal Service Corporation (ALSC), and Legal Services of North Louisiana (LSNL) sometimes help with execution for income-eligible clients

If the signing parent is incarcerated, prison social workers or facility legal counselors can often arrange notary access within the facility.

After the Signing

Make several certified copies. Keep the original in a safe place and carry copies to:

• School enrollment appointments
• Medical and dental offices
• Pharmacy visits for the child's prescriptions
• After-school programs and childcare providers

Some institutions will want to keep a copy on file. Having extras prevents delays.

Common Mistakes to Avoid

• Only one witness present — the mandate is invalid
• Pre-signing before meeting the notary — the notary must witness the act of signing
• Forgetting to date the document — the one-year clock runs from the execution date; an undated mandate creates ambiguity
• Using a generic "power of attorney" form from another state — Louisiana Civil Law requires the specific mandate format; common-law POA templates do not satisfy La. R.S. 9:951

If you want a complete walkthrough — from downloading the form through handling school and medical visits with your signed mandate — our Louisiana School and Medical Consent Guide covers every step, including what to do when an institution questions your paperwork.

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