Consent Form for Overnight Lodging with Non-Custodial Adult
This form is to be completed by the 4-H member’s parent/guardian when giving permission for
the child to room overnight with an adult who is NOT their parent or guardian.
I (name of parent/guardian) _________________________________________of
(county) _____________________________ understand that the New Mexico 4-H Youth
Development Program has a policy that restricts non-parent/non-guardian adults from rooming
with youth without the permission of their parent or guardian.
Therefore, as the parent/guardian of (name of youth) __________________________________
I allow my child to room with (name of adult)____________________________________ and I
accept the responsibility of any consequences and absolve the Cooperative Extension Agent,
County, District and State New Mexico Cooperative Extension Service from any and all
responsibility.
Signed______________________________________________ Date___________________
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