Parent Or Guardian Consent Form

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PARENT OR GUARDIAN CONSENT FORM
FULL NAME OF MINOR
FIRST
LAST
MIDDLE INITIAL
PROOF OF AGE (Minor must present a copy of proof of age that can be kept with personnel records).
Type of Document:
ADDRESS OF MINOR:
STREET
CITY
STATE
ZIP CODE
DATE OF BIRTH
AGE
SCHOOL DISTRICT IN WHICH MINOR LIVES:
SCHOOL MINOR ATTENDS:
NAME OF PARENT OR GUARDIAN:
RELATIONSHIP TO MINOR:
ADDRESS OF PARENT OR GUARDIAN:
TELEPHONE NUMBER:
STREET
CITY
STATE
ZIP CODE
I hereby certify that to the best of my knowledge and belief, the above statements are true and that the minor named above
may work with my approval.
_________________________________________________________
Signature of Parent or Guardian
Date Signed
Minors aged sixteen or seventeen who are to be employed during summer vacation months after the last day of the school
term in the spring and before the first day of the school term in the fall, in nonagricultural and nonhazardous employment as
defined by the “Fair Labor Standards Act of 1938”, 52 Stat. 1060.29 U.S.C.A. 201, and similar state statues, or in other
employment not prohibited to minors age sixteen or seventeen by law, shall not be required to provide an age and schooling
certificate as a condition of employment. In order to be hired for employment during summer vacation months, such minors
shall provide the employer with the following:
(1)
Evidence of proof of age in the same manner as proof of age is provided the superintendent of schools under
division C of section 3331.02 of the Revised Code.
(2)
A statement signed by the minor’s parent or guardian consenting to the proposed employment during the summer
vacation months. For the purpose of this section, in the absence of a parent or guardian a person over eighteen years
of age with whom the minor resides may sign such statement.
The employer shall retain a copy of the proof of age and the statement of consent with the minors employment
records.

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