10818_Exhibit 5_ParentAdult Affidavit.pdf
PDF 117 KB Posted
- Attached to
- #10818-RFP-C6-Pinellas JAC
- Solicitation number
- RFP-06582
- Issued by
- Pinellas County, Florida
About this file
This document is the Parent/Responsible Adult Release Affidavit for RFP #10818 issued by the Florida Department of Juvenile Justice (DJJ) and the Office of Probation and Community Intervention. The RFP is for the provision of administrative services, detention screening, security, and intake services at the Juvenile Assessment Center (JAC) serving Circuit 6, Pinellas County. The Respondent shall provide these services 24 hours per day, 7 days a week.
The affidavit requires the parent, guardian, or responsible adult to provide their personal information, including contact details, and attest that the information is true and factual. This document is likely part of the submission requirements for the RFP, which involves the DJJ and the Office of Probation and Community Intervention in the state of Florida, specifically the jurisdictions of Leon County and Tallahassee City.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
RFP # 10818
EXHIBIT 5
Department of Juvenile Justice Juvenile Assessment Center
Parent/Responsible Adult Release Affidavit
I, ____________________________________________________ Name attest that I am the _____________________________________of Parent/Guardian/Responsible Adult
________________________________________ whose address is Child’s Name
__________________________________________________, and Address date of birth is ________________________. I may be reached at
DOB
Home Phone Cellular Phone and/ or _________________________.
Pager
Parents Information
Date of Birth ___________________________
Type of Identification provided: ______________________________
I attest that the above information is true and factual.
Signature of Parent/Guardian/Responsible Adult Date
Witness
Reviewed By:
Intake Screener Date
Lead Screener Date
File details come from the government source that posted it. Updated .