Valley State Prison Inmate Family Council


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There is a new form for consent for minors.  Please make yourself familiar with the form if you have minors.  You can also download the form by clicking HERE.
I, _________(PARENT/LEGAL GUARDIAN)_________________________ give permission for:       
NAME: ______________________________ AGE: ________ DOB: _______________
NAME: ______________________________ AGE: ________ DOB: _______________
NAME: ______________________________ AGE: ________ DOB: _______________
NAME: ______________________________ AGE: ________ DOB: _______    ______
With             (NAME OF ACCOMPAYING ADULT)_           _ for one year. I understand this Authorization is to be updated annually and that the minor Birth Certificate, or a Certified copy of the Birth Certificate, from the County Recorders Office is required. Satisfactory Evidence of Proof of legal guardianship to said
minor(s) is required as an attachment to this authorization form.
I understand that this authorization can only be revoked IN WRITING, and will remain in effect for one(1) year, or until written notice of revocations is issued by the California Department of Corrections and Rehabilitation.
_                     (SIGNATURE OF PARENT/LEGAL GUARDIAN)_______         _        DATE__   _  
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
To visit           (INMATE NAME AND CDCR#)___________at a California State Prison or Institution