RFP10847_Exhibit5_ReleaseAffidavit.pdf
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- Attached to
- Department of Juvenile Justice (Department or DJJ) Solicitation # 10847 – Leon County Juvenile Asses
- Solicitation number
- RFP-08708
- Issued by
- Leon County, Florida
About this file
This document is an Exhibit 5 Release Affidavit from the Department of Juvenile Justice (DJJ) Solicitation #10847 for the Leon County Juvenile Assessment Center (JAC). The JAC provides administrative services, detention screening, intake screening, and security 24 hours per day, 7 days a week and serves Circuit 2 (Leon, Gadsden, Franklin, Wakulla, Jefferson, and Liberty Counties) and Circuit 3 (Taylor and Madison Counties) in the North Region of Florida. The Affidavit requires the parent, guardian, or responsible adult to provide their information and attest that the information is true and factual.
The DJJ and the Office of Probation and Community Intervention are issuing this RFP. No details are provided on pricing terms, set asides, incumbents, funding requirements or sources, or contract amounts. The document does not contain any non-essential legal language or contract clauses.
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Text version
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 .