Christian Heritage : Family Outreach : Father Son Hang Out Permission Slip

Your Name (Required)

Phone number (including area code) (Required)

Street or post office address (Required)

City, State, Zip Code (Required)

E-mail address

Emergency Contact Name (Required)

Emergency Contact Phone Number (Required)

Inmate's name (Required)

Institution (Required)

Name(s) of child(ren) (first, last) (Required)

Age(s) of child(ren) (Required)

Date of visit

Name of person transporting child(ren) to and from visit (Required)

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Are you the legal guardian of child(ren)?

I authorize investigation of all statements contained in this document as may be necessary in my child(ren) participating in the Father Son Hang Out.

I certify that the information given herein is true and complete and that the submission of this form is the same as my signing this form.

Today's date (Required)

Family Outreach