Visiting Application Minor Child

Resident’s Name: IDOC Number: Institution:
Is this a renewal application?  Yes  No
Child’s name: Date of birth: SSN:
Relationship to the resident:
In the legal and physical custody of:  Both natural parents  Mother  Father
Child’s name: Date of birth: SSN:
Relationship to the resident:
In the legal and physical custody of:  Both natural parents  Mother  Father
Child’s name: Date of birth: SSN:
Relationship to the resident:
In the legal and physical custody of:  Both natural parents  Mother  Father
Child’s name: Date of birth: SSN:
Relationship to the resident:
In the legal and physical custody of:  Both natural parents  Mother  Father
Mother’s name (or legal guardian):
Address:

Father’s name (or legal guardian):
Address:

I, , and give our consent for the
(Custodial Parent or Legal Guardian’s signature) (Non-custodial Parent’s signature)
above named minor children to visit, , a resident sentenced to the Idaho Department of Correction (IDOC).
Notary Section
State of
County of
On this day of , 20 , personally appeared before me

, known to me to be the person whose name is subscribed to the
(Name of affiant)
foregoing instrument, and swore and acknowledged to me that he executed the same for the purpose and in the capacity therein expressed, and that the statements contained therein are
true and correct.

Notary Public for Idaho
Residing at , Idaho
Commission expires:
Instruction: If the applicant is under 18 years of age, the parent or guardian accompanying the child on the visit must also submit the following: Visiting Application (Adult), and a
certified copy of the child’s birth certificate. In addition, Guardians must also submit a copy of the court order granting legal guardianship or a completed Power of Attorney Delegating
Limited Powers for Visitation form. All applications expire one year from the date submitted. A minor child’s application, after the initial approval, expires on the minor’s 16th birthday,
unless terminated earlier by the facility head or designee, minor, or parent/guardian. Each applicant is responsible for resubmitting a new updated application within these timeframes.