CALIENTE YOUTH CENTER  

CALIENTE, NEVADA  

   

CORRESPONDENCE AUTHORIZATION  

My child, has permission to write to and receive mail from, and/or place calls to and receive calls from the following individuals: You MUST specify the people whom you will permit him/her to correspond with by full legal name.  Please include the complete mailing address and telephone number.  If you do not include a phone number, we will assume your youth is NOT allowed to speak on the phone with that person.  Please complete the specific section for each person your youth is permitted to have contact with.  Any incomplete sections will not be accepted.

 

Child's Name
 
 
 
Authorized Person's Name
Authorized Person's Address
Authorized Person's Phone Number
 

Authorized Person's Relationship
 
 
 
Authorized Person's Name
Authorized Person's Address 
 
Authorized Person's Phone Number
Authorized Person's Relationship
 
 
Authorized Person's Name
Authorized Person's Address
 
Authorized Person's Phone Number
Authorized Person's Relationship
 
 
Parent/Guardian Name
Parent/Guardian Email
Parent/Guardian Telephone number
Parent/Guardian Home Address
 
Date Submitted

 

All Information to be verified by DCFS staff before activation