REQUEST FOR A LATER CURFEW

I, ______________________________(name of child) , on this day ____________________________ (date),

have asked to have my curfew extended from ______________________ (current curfew) to
__________________ (requested curfew).

I am asking to have my curfew extended on _____________________ (date) because I want to

__________________________________ (reason for request i.e. school dance).

I understand that

his is a one-time extension and that my curfew will remain ____________________ (current curfew) on
all other nights following this event. I was informed by ___________________
that if I should break this curfew on ________________________
______________________________________________

(date of event)

(Mom and/or Dad)

that I have to _____________

(punishment for breaking curfew).

I understand and agree that I also have to __________________________________________

__________________________

(i.e.: call home, call at a certain time etc.)

in order to be granted an extension

on my current curfew. I agree to all of these terms.

______________________________
Childs Signature

____________________________
Parents Signature

_________
Date