1 December 6, 2016 Immigrant Safety Plan for Youth and Children LCYC worked in close collaboration with the University of Washington School of Law Latina/o Student Association (UW LLSA), and UW Law alum, Katherine Brennan, to create this collective legal resource for the community. Northwest Justice Project (NJP) and Seattle University School of Law Latina/o Student Association (SU LLSA) also contributed time and resources. LCYC appreciates the collaboration of professionals and students in meeting an immediate community need. The below information was gathered to help families who are facing potential detainment or deportation of parents with children (children with or without status). This document is a collective community resource, **THIS IS NOT LEGAL ADVICE**. Families who are facing potential detainment or deportation of parents with children (children with or without status) should be preparing now and have the following documentation: The child’s school emergency contact information The child’s immunization records Intention of Parents for Care for Minor Child Temporary Parental Consent Agreement The child’s birth certificate (whether it is from US or another country) The child’s social security card The child’s passport The following information is arranged in sections corresponding to the bullet points above.
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1 December 6, 2016
Immigrant Safety Plan for Youth and Children
LCYC worked in close collaboration with the University of Washington School of Law Latina/o Student
Association (UW LLSA), and UW Law alum, Katherine Brennan, to create this collective legal resource
for the community. Northwest Justice Project (NJP) and Seattle University School of Law Latina/o Student
Association (SU LLSA) also contributed time and resources. LCYC appreciates the collaboration of
professionals and students in meeting an immediate community need.
The below information was gathered to help families who are facing potential detainment or deportation
of parents with children (children with or without status). This document is a collective community
resource, **THIS IS NOT LEGAL ADVICE**.
Families who are facing potential detainment or deportation of parents with children (children
with or without status) should be preparing now and have the following documentation:
The child’s school emergency contact information
The child’s immunization records
Intention of Parents for Care for Minor Child
Temporary Parental Consent Agreement
The child’s birth certificate (whether it is from US or another country)
The child’s social security card
The child’s passport
The following information is arranged in sections corresponding to the bullet points above.
2 December 8, 2016
Table of Contents
Care for Minor Children …………………………………………………………………………………......... 3
School Emergency Contact Information ................................................................................................ 5
Child Immunization Records ................................................................................................................. ..5
Intention of Parents for Care for Minor Child ........................................................................................ 6
WA Birth Certificate Form ………………………………………………………………………...........11
Social Security Card ............................................................................................................................... 12
Social Security Card Form ……………………………………………………………………..............13
US Passport Form ………………………………………………………………………........................20
Other Resources ..................................................................................................................................... 22
3 December 8, 2016
Care for Minor Child
This is not legal advice, but is intended to help families that may be in a situation where they may be
detained and/or deported and their children may be at risk. Parents may want someone to have the
legal power to care and/or make decisions on behalf of their child during this time. The documents in
this packet do not give someone legal custody of the child, only a court order can do that. Parents and
caregivers should consult a family law attorney to pursue legal custody. This document is intended to
only help the parents begin thinking about the process and explain their wishes. It can also be used to
help parents obtain education or medical documents that may help their children. Parents can also look
into a family preparedness plan at http://www.washingtonlawhelp.org/resource/family-preparedness-
plan?ref=Q1Gc6.
Parents should choose someone that can care for their child in the event of an
emergency/detainment/deportation. This person should be designated as the school emergency
contact person in the event that the parents are unreachable to pick up the child. Ask the administration
office for this form and fill it out. This person should have status and ideally is a family member (if it is
not a family member, the process becomes more complicated). This is very important. If the child can
get picked up by the emergency contact, the school may avoid calling the police if a child is not picked
up. However, while this may help temporarily, a family law attorney should be consulted for a change in
legal custody.
Another item that may be helpful is for the future caregiver to have a background check. Parents should
discuss with this person the wishes of the parents and make sure that the future caregivers understand
what they may need to do. Parents and caregivers should consult a family law attorney for this advice.
For more information on Family Law, see www.washingtonlawhelp.org.
It may be helpful to create the Intention of Parents for Care for Minor Child and Temporary Parental
Consent Agreement, which may give the caregiver very temporary legal rights (medical, educational
and travel) if the child is placed with them. This does not guarantee that the child will be placed with the
caregiver. In order to go through the process to place a child in the legal custody of someone other than
the parent, a family law attorney should be consulted.
Once the Intention of Parents for Care of Minor Child and the Temporary Parental Consent Agreement
is filled out and notarized (even though the documents state that they do not need to be notarized, they
should be notarized.), give the original to the caregiver (along with other important documents), keep a
copy for yourself and put a copy (ideally folded in a small plastic bag) in your child’s backpack. Let your
child know in the event of an emergency, he/she should show this paper to the authorities, the teacher
or whomever is talking to them about taking them to another home.
Parents should fill out an Intention of Parents for Care for Minor Children and a Temporary Parental
Consent Agreement. Each child should have one document filled out separately. Give the original to the
caregiver, keep a copy for yourself and put a copy (ideally folded in a small plastic bag) in your child’s
backpack. You should also have an electronic copy if that is possible. Do NOT put it on your phone. Let
your child know that in the event of an emergency, he/she should show this paper to the authorities, the
teacher or whomever is talking to the child about taking him/her to another home. Hopefully, the
This form does not need to be notarized to be valid.
SUBSCRIBED AND SWORN TO before me this ____ day of ____________ 20 . NOTARY PUBLIC in and for the State of Washington, residing at _. My commission expires: By __________________________________________ _____________________________________________ Notary Signature AGREED: ____________________________ Date: _______________ Parent/Caregiver ____________________________ Date: _______________ Parent/Caregiver
7 December 8, 2016
Temporary Parental Consent Agreement
1. I am/We are the parent(s) of
[child’s name], born on _______________ [birth
date]. I am/We are 18 years old or older.
2. I/We hereby give consent for [child’s
name] to remain in the residential care of __________________________________________
[caregiver’s name and relationship to the child] who live(s) at
[street, city, state]. The caregiver’s
phone number is: _______________________.
3. I/We hereby authorize this caregiver to have the care and control of the child, to make
health care decisions for the child, to have the authority to get and provide all necessary care,
including emergency and routine medical and dental care, evaluations and treatment, and to
make all necessary childcare and educational arrangements for the child while the child is in
her/his/their care with the following restrictions:
. I/We authorize the above named
caregiver(s) to make decisions on all other issues regarding the child [examples: religious
decisions, decisions about the child’s social life, decisions about the child’s school activities,
and personal care decisions (haircuts, pierced ears, and so on)] with the following restrictions:
.
4. I/We authorize this caregiver to take the child out of state for travel with the following
restrictions:
.
5. This agreement lasts until _____________________ [put an end date or “indefinitely”],
unless it is revoked before it expires. Either parent can revoke this consent and terminate this
agreement at any time by delivering to the caregiver a signed, written notice at least a week in
advance.
6. (The following paragraph applies if only one parent is available to consent) [ ] I am
the child’s sole custodian. The other parent has not signed this consent because
[explain whether the other parent is unknown or absent].
This form does not need to be notarized to be valid.
SUBSCRIBED AND SWORN TO before me this ____ day of ____________ 20 . NOTARY PUBLIC in and for the State of Washington, residing at My commission expires: By __________________________________________ _____________________________________________ Notary Signature AGREED: ____________________________ Date: _______________ Parent/Caregiver ____________________________ Date: _______________ Parent/Caregiver
9 December 8, 2016
Birth Certificates
Each child should have an original birth certificate. Copies of the certificate (paper and electronic
copies) should be made and given to others that may care for the child.
WASHINGTON STATE BIRTH CERTIFICATES (See form on Page 9)
Birth certificates are public records in the state of Washington so anyone can order a birth
certificate as long as they have the following information: Full name of the child, Birth date of the
child, Place of birth, Mother’s full name, Father’s full name.
a. Order by mail:
i. Download the form http://www.doh.wa.gov/Portals/1/Documents/Pubs/422-044-
BirthDeathMailInOrder.pdf
ii. Pay the $20 fee.
iii. Shipped within four weeks after payment. Can pay an additional fee for expedited
processing.
b. Order online:
i. Go to www.vitalcheck.com
ii. Pay the $31.50 fee.
iii. Shipped within two business days. Can pay an additional fee for expedited
processing.
c. Order by phone:
i. Call 360-236-4313, Monday – Friday from 9:00 a.m. to 4:30 p.m.
ii. Pay the $31.50 Fee.
iii. Shipped the next business day.
d. Order in person:
i. Walk-in to your local county Vital Statistics office or the Washington State Vital
Statistics Office located at 101 Israel Road SE Tumwater, WA 98501
ii. Pay the $20 fee
iii. You will receive the birth certificate the same day if order is placed before 4:00
pm.
UNITED STATES NON-WASHINGTON BIRTH CERTIFICATES
Search at http://www.cdc.gov/nchs/w2w/index.htm for more information on each state’s process.
MEXICAN BIRTH CERTIFICATES
a. Individuals can visit the consulate office without appointment between 9am and 1pm
(2134 3rd Ave, Seattle, WA 98121, phone (206) 448-3526)