[Your letterhead, if desired; if not, your return address]
[Date of letter—month, day, and year]
[Recipient's first and last names]
[Street or P.O. box address]
[City, State ZIP code]
Dear [recipient's name]:
I am writing to notify you that per our recent meetings and telephone conversations, I agree to take temporary custody of our two children, Sally (age 3) and Samuel (age 6), effective on August 16, 2010. I agree that the children will be living with me and that I will provide for all of their usual needs. I also agree that we will arrange visits between the children and you, which will take place twice per week.
I understand that we will revisit this child custody issue in three months and determine future custody arrangements then. Thank you for taking the time to discuss this highly important issue with me and for being reasonable in the process.
[Sender's first and last names]