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Sex Offender Informed Consent for Visitation of Minors
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Sex Offender Informed Consent for Visitation of Minors
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Last modified
12/20/2019 2:21:29 PM
Creation date
11/28/2017 12:10:13 PM
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Offender’s Information <br />Offender’s name: IDOC#: <br />Conviction history: <br />Age of victim(s): <br /> Person who has Legal Parental Rights <br />Statement of Understanding and Agreement <br />My Minor Child’s Name Date of Birth My Minor Child’s Name Date of Birth <br /> <br /> <br /> My Current Home Address: <br /> Street City State Zip <br />My Current Phone Numbers: <br /> Home Cell Other <br />In preparation of ‘s (hereinafter referred to as ‘the offender’) contact with my minor child/children, I have been informed of the offender’s conviction history and the age of <br />the victim(s). <br />I understand that the offender is in a treatment program and has earned the privilege of having contact with my minor child/children. I also understand that although the offender is <br />involved in treatment, it is possible for the offender to reoffend. <br />I agree to help the offender avoid any physical contact with my minor child/children. I also agree that under no circumstances will my minor child/children ever be left alone with the <br />offender (this includes being left alone in an automobile or room). <br />Based on the information given to me about the offender’s conviction history and the age(s) of the victim(s), I hereby give my informed consent for my minor child/children to have contact <br />with the offender. I understand that a copy of this form will be provided to the offender’s supervising probation and parole officer (PPO). <br />Furthermore, I understand that this form does not give or imply permission for the offender to have contact (supervised or unsupervised) with any other minors. I also understand that <br />any contact the offender has with minors, including my minor child/children, must be approved by the offender’s supervising PPO and treatment provider. <br /> <br />Parent’s Printed Name <br /> <br />Parent’s Signature Date <br />IDOC Approval <br /> Approved Denied <br />PPO’s Printed Name <br /> <br />PPO’s Signature Date <br /> Approved Denied <br />District Manager’s (or Designee’s) Printed Name <br /> <br />District Manager’s (or Designee’s) Signature Date
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