RFP10858_Exhibit 5_ParentResponsibleAffidavit.pdf
PDF 115 KB Posted
- Solicitation number
- RFP-10327
- Issued by
- Broward County, Graceville City, Florida
About this file
This is Exhibit 5, a Parent/Responsible Adult Release Affidavit form from the Department of Juvenile Justice's Juvenile Assessment Center. The document is a standard affidavit form that requires completion by a parent, guardian, or responsible adult to attest to their relationship with and responsibility for a juvenile in the system.
The form requires specific information including the parent/guardian's name, their relationship to the child, the child's name and address, date of birth, and contact information (home phone, cellular phone, and pager). Additional requirements include the parent's date of birth, type of identification provided, and signatures from the parent/guardian, a witness, an intake screener, and a lead screener with corresponding dates. The form features an official department seal or badge at the top of the document.
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| RFP 10858 Final.pdf | ||
| RFP10858_L_ ForeignCountry_Attestation.pdf | ||
| RFP10858_N_IntentToSubmit.pdf | ||
| RFP10858_Q_ProposalVerificationForm.pdf | ||
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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 .