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The DA 7666 form is a crucial document for individuals within the military, primarily used when there is a need to document parental consent for the care of minor children in various situations. Understanding this form is essential for military personnel who are parents or guardians, as it touches on several significant aspects of child care during periods of deployment, training, or any other assignment that necessitates a temporary guardian. The form outlines the specific consent given by the parent or legal guardian for the care of their child, details regarding the appointed guardian, and the duration for which the consent is valid. Proper completion and understanding of the DA 7666 ensure that the child’s welfare is legally safeguarded in the parent's absence, allowing for a comprehensive approach to delegate parental responsibilities and authority. It is a document that combines legal foresight with the practical necessities of military duties, ensuring that the child's needs and safety are a priority even when direct parental supervision is not possible.

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PARENTAL CONSENT

For use of this form, see AR 600-20; the proponent agency is DCS, G-1.

AUTHORITY: PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

PRIVACY ACT STATEMENT

10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.

To record the agreement of both parents with their child's custodial arrangement as documented in the Family Care Plan.

None.

Mandatory; failure to maintain a Family Care Plan could subject you to separation, administrative action, or disciplinary action under the UCMJ.

In accordance with this agreement the parties confirm the following stipulations of fact and terms of agreement:

 

 

,

a member of the United States Army, (hereinafter "the Soldier"), and

 

 

 

 

 

are the parents of

 

(hereinafter "the child"), date of birth

, born in

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The child currently resides primarily with

 

 

 

at

 

 

.

 

a.As a function of performing military duties, the Soldier may have to perform temporary duty, be deployed, or otherwise not be available to care for the minor child.

b.The Soldier has been notified that he or she is to be temporarily deployed. The time period of deployment has been estimated to be

in length. As a matter of military necessity, the minor child will not be able to reside with, or exercise access to the Soldier during this time. (Initial appropriate paragraph)

The parties agree that each has reviewed the attached Family Care Plan as set forth in Form DA 5305, which indicates that for the time period that the

Soldier is absent,

 

is to serve as the minor child's temporary physical guardian.

 

The parties agree that during this period the minor child will reside at

 

.

The parties agree that each will cooperate with the execution of any additional documentation as may be necessary to facilitate the designation of physical custody to the temporary guardian and effectuate this consent.

By the signatures below, each party indicates their consent to the arrangements outlined in the attached Family Care Plan and this agreement.

 

(SOLDIER'S SIGNATURE)

 

 

 

 

 

STATE OF

 

 

 

 

 

 

COUNTY OF

 

 

 

 

 

 

 

 

 

 

Acknowledged before me this

 

day of

,

.

 

 

 

 

 

 

 

 

 

 

 

(NOTARY PUBLIC)

My commission expires:

(OTHER PARENT'S SIGNATURE)

 

 

 

 

 

STATE OF

 

 

 

 

 

 

COUNTY OF

 

 

 

 

 

 

 

 

 

 

Acknowledged before me this

 

day of

,

.

 

 

 

 

 

 

 

 

 

 

 

(NOTARY PUBLIC)

My commission expires:

DA FORM 7666, SEP 2009

APD LC v1.01

File Characteristics

Fact Name Description
Form Identification DA Form 7666, Parental Consent Form for Access to Army Child and Youth Services (CYS).
Primary Use Used by parents or legal guardians to grant or deny consent for their children to participate in Army Child and Youth Services programs.
Applicable Users Parents or legal guardians of children and youth seeking to use Army CYS programs.
Required Information Includes child’s personal information, specific program consent, and emergency contact information.
Governing Law The form is governed by the regulations and policies of the U.S. Army and the Department of Defense regulations applicable to family and morale, welfare, and recreation programs.
Form Availability The form is available through official U.S. Army channels and can usually be obtained from the installation’s Child and Youth Services office.
Review and Approval Process Once completed, the form must be reviewed and approved by CYS staff to ensure compliance with Army policies before services can be provided to the child or youth.

Steps to Writing DA 7666

Completing the DA Form 7666 is a process that requires attention to detail and accuracy. This document is essential in various circumstances, particularly in the context of its specific applicability within the United States Army protocols. The form must be filled out with the utmost precision to ensure the information provided is correct and comprehensive. Below are the detailed steps that one needs to follow to properly complete the DA Form 7666 without making any errors. It's important to have all the necessary information on hand before starting to fill out the form to streamline the process.

  1. Start by gathering all required information that pertains to the specific purpose for which the DA Form 7666 is being filled out. This information may include personal identification details, unit identification, and the specifics of the request or action to be taken.
  2. Enter the date at the top right corner of the form. The date should reflect when the form is being filled out, using the DD/MM/YYYY format.
  3. Fill in the applicant's personal information. This section typically requires the full name, rank, and service number. Ensure that the information is accurate and corresponds to official identification documents.
  4. Specify the unit or department associated with the applicant in the designated field. This information is crucial for processing the form within the correct channels.
  5. If the form requires details about a specific event or situation, provide a comprehensive description in the section allocated for this purpose. Be concise yet thorough, ensuring all relevant facts are included.
  6. In sections that require a choice to be made or a box to be checked, do so clearly. If instructions specify to mark only one option, ensure that the selection is made decisively to avoid confusion.
  7. Any section that requests a signature or verification must be completed as instructed. This might include the signature of the applicant and, in some cases, the signature of a supervising officer. Ensure that all signatures are placed in their respective fields.
  8. Double-check the entire form upon completion to ensure no sections have been missed and that all information is presented accurately. Corrections, if any, should be made carefully to maintain the form’s readability.
  9. Follow any specific instructions for submission included with the form or provided by the authority requesting the form. Submission could be in person, by mail, or electronically, depending on the protocol.

Once the DA Form 7666 has been fully completed and reviewed for accuracy, it should be submitted according to the specific instructions provided for the form. Timely submission is crucial to avoid delays. After submission, it is advisable to keep a copy of the form for personal records and for future reference. The processing of the form will then be handled by the designated department or unit, and any further actions or responses will be communicated in accordance with the procedures established for the particular purpose for which the form was submitted.

Important Details about DA 7666

What is the DA 7666 form?

The DA 7666 form, officially known as the "Parental Consent Form for Medical Treatment," is a document used by the United States Army. It is designed for situations where minor children of military personnel require medical care, and their parents are not immediately available to give consent. This form authorizes designated individuals to consent to medical treatment on behalf of the parents.

Who needs to fill out the DA 7666 form?

Parents or legal guardians of minor children within the military community are the individuals required to fill out the DA 7666 form. This is particularly important for those who may have work obligations, deployments, or other circumstances that could prevent them from being readily available to make medical decisions for their children.

What information is required on the DA 7666 form?

To complete the DA 7666 form, accurate details about the child (such as full name, date of birth, and medical history), information about the parent or legal guardian (including contact details), and the designation of an authorized caregiver who can consent to medical treatments in the parent's absence are required. Additionally, specific medical treatments that the caregiver is authorized to consent to may need to be listed, depending on the form’s stipulations.

How long is the consent given through the DA 7666 form valid?

The duration for which the consent is valid may vary and should be specified on the form itself. Typically, it is advisable for the parent or guardian to renew the form annually or as significant life or legal changes occur, to ensure that the information and authorizations remain current and valid.

Where can one obtain a DA 7666 form?

DA 7666 forms are readily available through several channels within the military community. They can be acquired from medical facilities on military installations, family support centers, or legal assistance offices. Additionally, the form may be available for download from official military or Department of Defense websites, ensuring accessibility for service members and their families.

Is it required to have the DA 7666 form notarized?

While the necessity for notarization can vary based on specific requirements provided by the military installation or the form itself, it is generally recommended to have the DA 7666 form notarized to affirm the legitimacy and validity of the parent or legal guardian's consent. Legal assistance offices on military installations often provide notary services to service members and their families for this purpose.

Common mistakes

One common mistake individuals make when filling out the DA 7666 form is not reviewing the instructions beforehand. The form contains specific directions for each section, and neglecting these can lead to errors. It's essential to read and understand the guidance provided to ensure accurate completion.

Many people also fail to provide complete information in each section of the form. Every field is designed to gather necessary details, and leaving sections blank can result in processing delays. It's important to fill out each part fully and accurately.

Another error often seen is the incorrect use of abbreviations or acronyms. While some forms and documents allow for these, the DA 7666 requires full names, titles, and terminology. This mistake can cause confusion and incorrect processing of the form.

Misunderstanding the signature requirements represents another common pitfall. Signatories sometimes overlook the need for signatures in specific sections or use digital signatures where an ink signature is demanded. Checking the signature guidelines is critical for the form's validity.

Incorrectly formatting dates is a frequent issue as well. The DA 7666 specifies the required date format, and deviations from this can lead to misunderstandings about timelines or deadlines associated with the form.

Individuals often neglect to verify their personal information before submitting the form. Errors in personal details, such as misspelled names or incorrect ID numbers, can significantly delay processing and might require resubmission of the form.

Overlooking the requirement to attach supplementary documents is another oversight. The DA 7666 form may require additional documentation, and failure to include these can render the submission incomplete.

Using an outdated version of the form is a mistake with potentially serious implications. The most current version incorporates the latest requirements and guidelines. Submitting an outdated form can result in its rejection.

Lastly, not keeping a copy of the completed form for personal records is a common oversight. Having a personal copy is important for reference, especially if questions arise from the processing agency or if the form needs to be resubmitted.

Documents used along the form

The DA 7666 form is primarily used by the United States Army for parental consent regarding family care plans. This critical document ensures that service members have suitable care arrangements for their dependents, particularly in situations where the service member must be away for extended periods due to deployment, training, or other duties. Alongside the DA 7666, there are several other forms and documents that are often utilized to ensure that all aspects of family care and legal responsibilities are thoroughly documented and legally binding. These additional documents play vital roles in safeguarding the welfare of dependents and ensuring the service member's readiness and peace of mind.

  • DA Form 5305: This form serves as a Family Care Plan, which is essential for service members to detail their plans for family care during their absence. It complements the DA 7666 by providing a comprehensive outline of the proposed care arrangements.
  • DD Form 1172-2: Used to apply for and renew military identification cards for dependents, this form is critical for ensuring family members have continued access to military benefits and services.
  • DA Form 5841: Known as a Power of Attorney, this document allows a designated individual to make decisions and perform necessary actions on behalf of the service member’s dependents in their absence.
  • DD Form 2558: This Authorization to Start, Stop, or Change Basic Allowance for Housing (BAH) is crucial for adjusting housing benefits based on family care plans and dependent status.
  • DA Form 3349: This form is for Physical Profile documentation, which may be necessary when a dependent needs special medical considerations, possibly impacting the family care plan provisions.
  • DA Form 31: A Request and Authority for Leave document that allows service members to take leave for family care planning or emergencies, complementing the family care strategy outlined in the DA 7666 and DA 5305.

Together, these documents ensure that service members can fulfill their duty while also providing for the welfare and stability of their families. Each form addresses different aspects of family and dependent care, from legal authorization to logistical support, and health care, to housing allowances. Completing and maintaining these documents is crucial for the readiness and resilience of military families, particularly during periods of separation due to deployment or training.

Similar forms

The DA Form 7666, Parental Consent, shares similarities with the Department of Defense Form 1172, Application for Identification Card/DEERS Enrollment. Both forms are crucial in the process of enrolling family members in military-related benefits. The DA Form 7666 is necessary for obtaining parental consent for various activities and programs, while the DD Form 1172 is required for enrolling dependents into the Defense Enrollment Eligibility Reporting System, allowing them to receive military ID cards and access benefits. Each form plays a pivotal role in linking family members to military services and benefits.

Likewise, the DA Form 2028, Recommended Changes to Publications and Blank Forms, bears resemblance to the DA Form 7666 in its administrative nature. Although the DA Form 2028 is used for submitting suggestions for improvements to Army publications and forms, both documents facilitate a feedback loop within Army operations. They each serve as a means for individuals to communicate their needs or recommendations to higher authorities, emphasizing the importance of individual input in organizational processes.

The Consent for Medical Treatment form, used widely across various healthcare settings, also shares common ground with the DA Form 7666. These documents are both designed to ensure informed consent is formally recorded. The DA Form 7666 captures parental consent for minors participating in certain activities, while the Consent for Medical Treatment form documents agreement to medical procedures. Each serves a protective legal function for both the provider and recipient of the service or activity.

The School Permission Slip is another document similar to the DA Form 7666, as it is also used to obtain parental or guardian consent. School Permission Slips often seek approval for students to participate in school trips or events, similar to how the DA Form 7666 might be used for activities associated with military family programs. Both ensure that guardians are informed and agree to the participation of their ward in specific activities.

The Family Educational Rights and Privacy Act (FERPA) Release Form is akin to the DA Form 7666 in its emphasis on privacy and consent. The FERPA Release Form is utilized in educational institutions to gain permission to share a student's educational records, similar to how the DA Form 7666 might be used to authorize participation in programs that require sharing of certain personal details. Both are vital in protecting the privacy and rights of individuals.

The DA Form 31, Request and Authority for Leave, parallels the DA Form 7666 through its process of requesting permission. While the DA Form 31 is specifically for soldiers to request leave from their duties, the DA Form 7666 involves parental consent for minors. Each document necessitates an authority's approval before proceeding with the requested action, highlighting the structured decision-making within organizations.

The Child Travel Consent form is also comparable to the DA Form 7666. This document is used to grant permission for minors to travel without their parents or guardians, similar to how DA Form 7666 might permit participation in special programs or activities. They both play a crucial role in ensuring minors are safeguarded and allowed to partake in activities under authorized consent.

The HIPAA Release Form, which permits the sharing of an individual's health information with specified parties, mirrors the DA Form 7666 in terms of consent and privacy protection. While the DA Form 7666 might cover a broad range of consent-related needs within the military context, the HIPAA Release Form is specifically focused on health information. Each form respects the individual's privacy while facilitating necessary communication.

The Volunteer Consent Form, used by various organizations to obtain agreement from participants for voluntary services, aligns with the DA Form 7666. While one is tailored toward voluntary services, the DA Form 7666 can be seen as a means to consent to participation in specific military-affiliated programs. They each ensure volunteers or participants are aware of and agree to the terms and conditions of their involvement.

Lastly, the Parental Acknowledgment of Student Conduct Code is similar to the DA Form 7666, as it also seeks parental acknowledgment and consent, this time regarding behavior and ethical expectations in an educational setting. Like the DA Form 7666, which might cover consent for participation in behaviorally based programs or activities, this document ensures parents are informed and agree to certain standards of conduct for their children. Both types of forms promote understanding and agreement on expectations and rules.

Dos and Don'ts

Filling out the DA 7666 form, a crucial document for certain processes, requires precision and attention to details. Incorrect or careless completion can lead to delays or significant issues. To guide through this process, here are seven essential dos and don'ts:

  • Do thoroughly read all instructions before starting to fill out the form to ensure you understand the requirements and provide accurate information.
  • Do use black ink or type your responses if the form is fillable online. This ensures all information is legible and can be processed without errors.
  • Do double-check your entries for accuracy, especially numbers and dates, which are commonly mistyped but can have significant repercussions.
  • Do provide complete information in all required fields. Incomplete forms may be returned or delay the process you are involved in.
  • Do not skip sections that apply to your situation. If a section doesn’t apply, it’s better to mark it as "N/A" (not applicable) rather than leaving it blank to demonstrate that you acknowledged every part of the form.
  • Do not use correction fluid or tape. If you make a mistake, it is advisable to start over with a new form to ensure the document remains neat and readable.
  • Do not forget to sign and date the form where required. Unsigned or undated forms are considered incomplete and cannot be processed.

By following these guidelines, you can ensure the DA 7666 form is filled out correctly and efficiently, facilitating a smoother process for the tasks or procedures the form is intended for.

Misconceptions

The DA 7666 form, often surrounded by confusion and misinformation, plays a crucial role within certain procedures, but there are several misconceptions that need to be addressed. Below are five common misunderstandings and the truths behind them.

  • It’s Only for Military Personnel: A common misconception is that the DA 7666 form is exclusive to active-duty military personnel. In truth, this form can also be applicable to civilians working within the Department of Defense, as well as reservists and National Guard members under certain conditions.

  • It’s Only Used for Disciplinary Actions: Many believe the DA 7666 is solely for documenting disciplinary actions. However, it's actually a versatile form used for various administrative purposes, including but not limited to, requesting specific services or support, documenting counseling sessions, and other HR-related processes.

  • Approval is Guaranteed: Filling out the DA 7666 form does not guarantee approval of the request or action it seeks. The decision ultimately depends on several factors, including the necessity, availability of resources, and adherence to policies and guidelines of the Department of Defense or the specific branch involved.

  • It’s a Long and Complicated Process: The thought of dealing with government forms can be daunting, leading some to assume the process of completing the DA 7666 is long and complex. While accuracy and thoroughness are important, the form itself is designed to be straightforward as long as the instructions are carefully followed.

  • Personal Information is At Risk: In today’s digital age, the concern for personal information security is paramount. Some might worry that submitting the DA 7666 puts their personal information at risk. Rest assured, the handling and storage of these forms are subject to strict privacy regulations and protocols to protect personal information.

Understanding the truth behind these misconceptions about the DA 7666 form ensures its appropriate and effective use within the prescribed procedures. Being well-informed allows individuals to navigate the process with confidence, knowing they are fully compliant with the necessary regulations.

Key takeaways

The DA 7666 form, known officially as the "Parental Consent for Administration of Pediatric Psychotropic Medication to a Minor," is a critical document within the U.S. Army's medical protocol. This form ensures that healthcare providers obtain explicit consent from parents or guardians before administering psychotropic medications to minors. While the DA 7666 may appear straightforward, various key points should be understood to effectively fill out and use this form.

  • Identification of the Minor: Clearly provide the full name, date of birth, and other relevant identification details of the minor for whom the psychotropic medication is being considered.
  • Comprehensive Medication Information: The form requires detailed information about the prescribed medication, including the name, dosage, potential side effects, and intended benefits, ensuring that guardians are fully informed.
  • Documenting Guardian Consent: The DA 7666 form serves as a legal document where a parent or guardian gives explicit consent for the administration of the medication, highlighting the importance of accurately capturing the guardian’s decision.
  • Healthcare Provider Responsibilities: It outlines the responsibilities of healthcare providers to offer thorough explanations and to address any questions or concerns the guardians might have regarding the medication's use.
  • Review and Explanation: The form requires a healthcare provider to review all the sections with the parent or guardian, ensuring a comprehensive understanding before consent is given.
  • Signature Section: Both the healthcare provider and the parent or guardian must sign the form, which validates the agreement and consent for treatment. Make sure these signatures are dated.
  • Record Keeping: Once completed and signed, the DA 7666 form becomes part of the minor's medical record, mandating proper filing and confidentiality in handling.
  • Revocation of Consent: Guardians have the right to revoke their consent at any time. This action should be documented and processed in accordance with military medical protocols.
  • Use in Military Installations: The form is specifically designed for use within military installations, ensuring that military dependents under the age of 18 receive psychotropic medications only with proper consent.
  • Annual Review: In cases where long-term medication is prescribed, the consent must be reviewed and renewed on an annual basis, or as directed by healthcare professionals, to accommodate any changes in the minor’s health status or medication requirements.

Understanding these key points about the DA 7666 form can greatly assist military families and healthcare providers in ensuring the safe and legally compliant use of psychotropic medications for minors. Always consult with a military healthcare provider for the most current guidance related to its use and completion.

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