SUMMIT VIEW YOUTH CENTER

REQUEST FOR FAMILY VISITATION FORM

Our visiting schedule:

Fridays (4p-6p & 6p-8p)
Saturdays (8a-10a; 10a-12p; 12p-2p; 2p-4p)
Sundays (8a-10a; 10a-12p; 12p-2p; 2p-4p)
Mondays (4p-6p & 6p-8p)

Note: Out of town visitors may be allotted more time for visits (rather than choosing 1 2-hr block)

Name of Youth:
Date of Proposed Visit:
Time:
Person Requesting Visit
Contact Phone Number:
Contact Email Address:

Visitor 1:
Relationship:
Age:

Visitor 2:
Relationship:
Age:

Visitor 3:
Relationship:
Age:
For additional visitors, please submit additional requests.
Date Submitted:
Note: Immediate family only for visitations. Exceptions may be approved by the Superintendent or Lieutenant. No visitors under 16 unless accompanied by an approved adult visitor.