Child Safty Form

Form
Family name (name of inmate you wish to visit)
Given Name (s)
I ,
parent or accompanying adult of the following child/children, absolve theCorrectional Service of Canada from any responsibility it may have in allowing the said child/children to accompany me on a visit to the CSC Institution/facility.
For greater certainty, but not so as to restrict the generality of the foregoing terms, I exonerate the Correctional Service of Canada or its servants for any responsibility resulting from an injury sustained by the said child/children while on federal property. I also waive my rights to any claims or actions which I may have against the Correctional Service of Canada or its servants resulting from the admission of the said child/children in a federal institution. Finally, I acknowledge that I am responsible for the following child/children at all times while he/she is in the institution.
First and Last name of visiting child/children)
Date

MonthDayYear
Date
First and Last name of visiting child/children)
Date

MonthDayYear
Date
First and Last name of visiting child/children)
Date

MonthDayYear
Date
First and Last name of visiting child/children)
Date

MonthDayYear
Date
First and Last name of visiting child/children)
Date

MonthDayYear
Date
First and Last name of visiting child/children)
Date

MonthDayYear
Date
Signature of the above-mentioned parent oraccompanying adult

Clear
Signature of the above-mentioned parent oraccompanying adult

Clear
Date

MonthDayYear
Date
Should be Empty: