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Child Labor Laws and Farm Workers – Parental Permission Authorization Form

Youth Farm Worker Parental Authorization

Name of child: __________________________-

Birthdate:  __________________

Address where child resides:  ___________________

 

Custodial parent/guardian: Non-Custodial parent/guardian
Name Name
Address Address
Phone Phone
Email Email

 
Does parent have sole or primary custody?

 
Emergency contact:  __________________________

 

 
I give my child permission to work at the following farm:  _____________________________

 
__________________________            ____________________
Signature                                                 Date