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

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

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