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FORM: Registration of Minor Children

A parent or legal guardian of a minor must fill out this form to provide written authorization for the correspondence between an inmate and a minor. One form per minor must be completed.

Registration of Minor Child for Correspondence with an Inmate

* Complete one form for each minor*

K.A.R. 44-12-601
(11)(A) No inmate shall correspond with a minor, either directly or through any third party, unless one of the following conditions is met: (i) A parent or legal guardian of the minor has filed written authorization for the correspondence between the inmate and the minor with the director of victim services in the department of corrections central office. (ii) If the minor is the inmate’s natural or adoptive child, the correspondence is authorized pursuant to paragraph (b)(10)(C), and the inmate has registered the child by providing the name, date of birth, and address of the natural or adoptive child to the director of victim services. (B) The director of victim services shall notify the warden of the facility where the inmate is incarcerated of any written authorization for correspondence with a minor who is not the natural or adoptive child of the inmate, as well as the registration information of the inmate’s natural or adoptive child.

All requested information must be completed to submit form.

Inmate's Information

Inmate's First Name:   Type in first name of inmate.

Inmate's Last Name:   Type in last name of inmate.

Inmate Number:   Type in inmate's KDOC registration number.

Minor's Information

Enter information for one minor only. A separate form must be completed and submitted for each minor.

Minor's First Name:   Type in first name of minor.

Minor's Last Name:   Type in last name of minor.

Date of Birth of Minor:   Enter date of birth of minor.

Year -- 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 / Month -- January February March April May June July August September October November December / Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  

Address of minor:   Enter address of residence for minor.

City of minor's residence:   Type in city of residence for minor.

State of minor's residence   Select state of residence of minor. If not residing in the U.S., please select OTHER at bottom of list and fill in complete address for minor in requesting field below. -- Select -- ALABAMA - AL ALASKA - AK ARIZONA - AZ ARKANSAS - AR CALIFORNIA - CA COLORADO - CO CONNECTICUT - CT DELAWARE - DE DISTRICT OF COLUMBIA - DC FLORIDA - FL GEORGIA - GA HAWAII - HI IDAHO - ID ILLINOIS - IL INDIANA - IN IOWA - IA KANSAS - KS KENTUCKY - KY LOUISIANA - LA MAINE - ME MARYLAND - MD MASSACHUSETTS - MA MICHIGAN - MI MINNESOTA - MN MISSISSIPPI - MS MISSOURI - MO MONTANA - MT NEBRASKA - NE NEVADA - NV NEW HAMPSHIRE - NH NEW JERSEY - NJ NEW MEXICO - NM NEW YORK - NY NORTH CAROLINA - NC NORTH DAKOTA - ND OHIO - OH OKLAHOMA - OK OREGON - OR PENNSYLVANIA - PA RHODE ISLAND - RI SOUTH CAROLINA - SC SOUTH DAKOTA - SD TENNESSEE - TN TEXAS - TX UTAH - UT VERMONT - VT VIRGINIA - VA WASHINGTON - WA WEST VIRGINIA - WV WISCONSIN - WI WYOMING - WY OTHER - Non-U.S

Zip code of minor's residence:   Type in zip code of residence for minor.

Non-U.S. resident address Type in complete address for minor who is a non-U.S. resident.

Parent's/Legal Guardian's Information

By typing the name and submitting this request, the person thereby verifies that it is that person’s signature and request under the penalty of perjury.   Check box to certify.

Full Name of Parent/Legal Guardian Submitting Form:   Type in your first name and last name as parent/legal guardian of minor.