MINOR REQUEST TO VISIT FORM - Bristol County Sheriff`s Office

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