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