Bcso Classification Form Minor Request To Visit printable pdf download

Bristol County Sheriff’s Department

Minor Request to Visit Form

TO THE PARENTS OR LEAGL GAURDIANS OF MINOR:

Please complete and return the enclosed application for permission to bring a minor into the Bristol County House of Correction & Jail for visits.

This form must be notarized and signed in the presence of a notary. Once the facility has received your completed and notarized request we will

consider your request and notify the inmate whether or not this request has been approved or denied. The inmate will mail the Approved original

Minor Request to Visit Form to you.

For Communications Purpose Only.

NOTE: Approved minor visitors will be required to have a birth certificate as identification

At the time of each visit, along with the original approved Minor Request to Visit Form.

_______________Date

Mail completed forms to: BCSO

Attention: Communications Division

_____________ Disp.Initials

400 Faunce Corner Road

BOP

North Dartmouth, MA 02747

Warrant

No Disposition

Date: _______________________________

Other _______________________

1.Name Of Minor: Please Print __________________________________________________________________________________

Last

First

Middle

2. Date of Birth of Minor: _____________________________ 3. Relationship of Minor to Inmate:_________________________

4. Name of Inmate to be visited: ____________________________________________________________________________

Print name of inmate

ID #

5. Any restrictions to be placed on visit by Minor (i.e. can be only be escorted by named individual note: (any individual listed here

also needs to be approved as visitor.)___________________________________________________________________________

6. Address of Parent or Guardian: ________________________________________________ Phone #_____________________

City/ State/Zip: ____________________________________________________________

PLEASE MAKE SURE THIS APPLICATION IS NOTARIZED!

_________________________________________________

__________________________________________________

Signature of parent or Legal Guardian

Printed Name of Parent or Legal Guardian

Commonwealth OF MASSACHUSETTS

Bristol, SS.

___________________, 20___________

On this ___________day of _________________,20__________, before me, the undersigned notary public, personally appeared

_________________________________________________________, proved to me through satisfactory evidence of identification,

which were ________________________________________, to be the person whose name is signed on the preceding or attached

document in my presence.

__________________________________________________

Notary Public (official signature and seal of notary)

My commission expires: ______________________________

To be completed by BCSO personnel

------------------------------------------------------------------------------------------------------------------------------------------------------------------

Make a copy of this document for the 6-part file and provide the original document to the inmate to send to visitor.

To: __________________________________________________________________________________

Inmate Name

ID #

Name of Minor visitor: ___________________________________________________________________________________

After reviewing this visit request and all relevant information, I have decided to

( ) Approve this request

(

) Deny this request

REASON FOR DENIAL: ____________________________________________________________________________

________________________________________

____________________

BCSO CLASSIFICATION FORM

REVISED 05/17/2010

Bcso Classification Form Minor Request To Visit

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