{"id":129417,"date":"2025-01-30T15:22:43","date_gmt":"2025-01-30T23:22:43","guid":{"rendered":"https:\/\/jonestown.sdsu.edu\/?page_id=129417"},"modified":"2025-08-18T15:16:21","modified_gmt":"2025-08-18T22:16:21","slug":"parental-consent","status":"publish","type":"page","link":"https:\/\/jonestown.sdsu.edu\/?page_id=129417","title":{"rendered":"Parental Consent (text)"},"content":{"rendered":"

[Page 5]<\/p>\n

PARENTAL CONSENT
\nAND POWER OF ATTORNEY<\/p>\n

STATE OF CALIFORNIA
\nCOUNTY OF SAN FRANCISCO
\nUNITED STATES OF AMERICA<\/p>\n

I, [name], hereby declare:<\/p>\n

    \n
  1. I am the natural _____ [mother or father]\/legal guardian\/of _____ [name of minor], a minor, born _____ [birthdate].<\/li>\n
  2. I hereby consent to said minor going to Guyana, South America, to live and be cared for there under the Guardianship or custody of _____ [name] or whomever she appoints in her place.<\/li>\n<\/ol>\n

    I hereby appoint [spaces for three names and addresses] as my attorneys-in-fact, jointly and severally, to take any and all action any of them deem fit for the welfare of said minor. By this power of attorney, I give each of the aforesaid attorneys-in-fact the right to the care, custody, supervision, and control of said minor anywhere throughout the world, and to travel anywhere with said minor throughout the world.<\/p>\n

    Executed on this [date],
    \n197___, at ____ [location], California
    \nSIGNED ____<\/p>\n

    [Page 6]<\/p>\n

    STATE OF CALIFORNIA
    \nCOUNTY OF SAN FRANCISCO
    \nUNITED STATES OF AMERICA<\/p>\n

    On _____ [date], before me, the Undersigned, a Notary Public in and for said County and State, personally appeared _______[name], known to me to be the person whose name is subscribed to the within instruments and acknowledged to me that ___ executed the same.<\/p>\n

    WITNESS MY HAND AND OFFICIAL SEAL: _____<\/p>\n

    [Pages 7 and 8 are the duplicate of pages 5 and 6]<\/p>\n

    —–<\/p>\n

    The forms all appear in RYMUR 89-4286-B-1-a-, with the page number(s) indicated below. The names of the minors are in alphabetical order. The date of signature also appears next to the name.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Name of Minor<\/strong><\/td>\nName of Parent\/ Guardian<\/strong><\/td>\nDesignated Attorney-in-fact<\/strong><\/td>\nDate of Signature<\/strong><\/td>\nTemple Notary<\/strong><\/td>\nPage number(s)<\/strong><\/td>\n<\/tr>\n
    Maurice Anderson<\/td>\nRichardell Perkins (mother)<\/td>\nDebbie Touchette, Joyce Touchette, Mary Lou Clancey<\/td>\nApril 27, 1977<\/td>\nJames R. Randolph<\/td>\nm-2a \u2013 m-2b<\/td>\n<\/tr>\n
    Shantrell Anderson<\/td>\nDan Anderson (father)<\/td>\nPaula Adams, Joyce Touchette<\/td>\nMay 17, 1977<\/td>\nJames R. Randolph<\/td>\nm-3a \u2013 m-3b<\/td>\n<\/tr>\n
    Dante Augustine Carroll III<\/td>\nBetty J. Carroll (mother)<\/td>\nPaula Adams, Joyce Touchette, Debbie Blakey, Maud Perkins<\/td>\nApril 5, 1977<\/td>\nMartha E. Klingman<\/td>\nm-4a \u2013 m-4b<\/td>\n<\/tr>\n
    Eric Baker<\/td>\nBarbara Baker (mother)<\/td>\nPaula Adams, Joyce Touchette, Debbie Blakey, Jair Baker<\/td>\nApril 17, 1977<\/td>\nMartha E. Klingman<\/td>\nm-5a \u2013 m-5b<\/td>\n<\/tr>\n
    Yolanda Brown<\/td>\nRoseanna Dickerson (grandmother)<\/td>\nPaula Adams, Joyce Touchette, Debbie Blakey, Luella Holmes Brown<\/td>\nApril 9, 1977<\/td>\nJames R. Randolph<\/td>\nm-7a \u2013 m-7b<\/td>\n<\/tr>\n
    Beyonka Cameron<\/td>\nMary Johnson (mother)<\/td>\nJoyce Touchette, Debbie Blakey, Debbie Touchette, Diana Marshall<\/td>\nApril 3, 1977<\/td>\nJames R. Randolph<\/td>\nm-8a \u2013 m-8b<\/td>\n<\/tr>\n
    Michkell Carroll<\/td>\nJoAnn Carroll (mother)<\/td>\nPaula Adams, Joyce Touchette, Debbie Blakey, Cynthia Davis<\/td>\nApril 5, 1977<\/td>\nJames R. Randolph<\/td>\nm-9a \u2013 m-9b<\/td>\n<\/tr>\n
    Randall Carroll<\/td>\nJoAnn Carroll (mother)<\/td>\nPaula Adams, Joyce Touchette, Debbie Blakey, Maud Perkins<\/td>\nApril 1, 1977<\/td>\nJames R. Randolph<\/td>\nm-10a \u2013 m-10b<\/td>\n<\/tr>\n
    Gail Chaikin<\/td>\nPhyllis Chaikin (mother)<\/td>\nPaula Adams, Debbie Touchette, Debbie Blakey, Alvarey Satterwhite<\/td>\nApril 1, 1977<\/td>\nJames R. Randolph<\/td>\nm-11a \u2013 m-11b<\/td>\n<\/tr>\n
    Angela Connesero<\/td>\nVersie Connesero (mother)<\/td>\nPaula Adams, Debbie Touchette, Debbie Blakey, Sharon Cobb<\/td>\nApril 8, 1977<\/td>\nChristine Kice<\/td>\nm-12a \u2013 m-12b<\/td>\n<\/tr>\n
    Dawnyelle Fitch<\/td>\nMichelle Wagner (mother)<\/td>\nPaula Adams, Joyce Touchette, Robert Christian<\/td>\nJune 28, 1977<\/td>\nJames R. Randolph<\/td>\nm-13a \u2013 m-13b<\/td>\n<\/tr>\n
    Dawnyelle Fitch<\/td>\nDonald Wagner (father)<\/td>\nDebbie Blakey, Paula Adams, Joyce Touchette, Robert Christian<\/td>\nApril 6, 1977<\/td>\nMartha E. Klingman<\/td>\nm-14a \u2013 m-14b<\/td>\n<\/tr>\n
    Raymond Fitch<\/td>\nBetty Fitch (mother)<\/td>\nDebbie Blakey, Paula Adams, Joyce Touchette, Geraldine Bailey, Ernestine March<\/td>\nMarch 27, 1977<\/td>\nChristine Kice<\/td>\nm-15a \u2013 m-15b<\/td>\n<\/tr>\n
    Laketta Franklin<\/td>\nRichardell Perkins (mother)<\/td>\nJoyce Touchette, Debbie Touchette, Maud Perkins<\/td>\nApril 27, 1977<\/td>\nJames R. Randolph<\/td>\nm-16a \u2013 m-16b<\/td>\n<\/tr>\n
    Kimberly Fye<\/td>\nGenevieve Cheek (mother)<\/td>\nDebbie Blakey, Paula Adams, Joyce Touchette, Mary Lou Clancey, Viola Forks<\/td>\nApril 11, 1977<\/td>\nJames R. Randolph<\/td>\nm-17a \u2013 m-17b<\/td>\n<\/tr>\n
    Will Gallie<\/td>\nSue Ellen Williams (mother)<\/td>\nDebbie Blakey, Paula Adams, Joyce Touchette, Patricia Grunnet<\/td>\nMarch 31, 1977<\/td>\nJames R. Randolph<\/td>\nm-18a \u2013 m-18b<\/td>\n<\/tr>\n
    John Lawrence Gardner<\/td>\nRuby Carroll (mother)<\/td>\nThomas David Kice, Paula Adams, Joyce Touchette<\/td>\nOctober 20, 1976<\/td>\nJames R. Randolph<\/td>\nm-19a \u2013 m-19b<\/td>\n<\/tr>\n
    Shonda Gaylor<\/td>\nShirley Thompson (mother)<\/td>\nDebbie Touchette, Joyce Touchette, Naomi [Naoma] Johnson<\/td>\nAugust 4, 1977<\/td>\nMartha E. Klingman<\/td>\nm-20a \u2013 m-20b<\/td>\n<\/tr>\n
    Dawn Gardfrey<\/td>\nBeverly Mitchell (mother)<\/td>\nRuby Johnson<\/td>\nAugust 2, 1977<\/td>\nCharlys Mae Wilson<\/td>\nm-21<\/td>\n<\/tr>\n
    Dominique Gardfrey<\/td>\nBeverly Mitchell (mother)<\/td>\nRuby Johnson<\/td>\nAugust 2, 1977<\/td>\nCharlys Mae Wilson<\/td>\nm-22<\/td>\n<\/tr>\n
    Brian Guy<\/td>\nOttie Mese Guy (mother)<\/td>\nDebbie Blakey, Joyce Touchette, Paula Adams, Cheryl Wilhite<\/td>\nApril 17, 1977<\/td>\nMartha E. Klingman<\/td>\nm-23a \u2013 m-23b<\/td>\n<\/tr>\n
    Keith LeJon Guy<\/td>\nOttie Mese Guy (mother)<\/td>\nJoyce Touchette, Paula Adams, Cheryl Wilhite<\/td>\nApril 17, 1977<\/td>\nMartha E. Klingman<\/td>\nm-24a \u2013 m-24b<\/td>\n<\/tr>\n
    Dorothy Harris<\/td>\nWillie M. Harris (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Virginia Taylor<\/td>\nApril 3, 1977<\/td>\nMartha E. Klingman<\/td>\nm-26a \u2013 m-26b<\/td>\n<\/tr>\n
    Judy Houston<\/td>\nPhyllis Houston (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Dorothy Rollins<\/td>\nApril 10, 1977<\/td>\nMartha E. Klingman<\/td>\nm-27a \u2013 m-27b<\/td>\n<\/tr>\n
    Patricia Houston<\/td>\nPhyllis Houston (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey<\/td>\nOctober 5, 1976<\/td>\nMartha E. Klingman<\/td>\nm-28a \u2013 m-28b<\/td>\n<\/tr>\n
    Ava Inghram<\/td>\nAlice Inghram (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Maria Katsaris<\/td>\nAugust 30, 1976<\/td>\nJames R. Randolph<\/td>\nm-29a \u2013 m-29b<\/td>\n<\/tr>\n
    Eileen Jackson<\/td>\nCorrine Kice (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Amanda Fair<\/td>\nApril 1, 1977<\/td>\nMartha E. Klingman<\/td>\nm-30a \u2013 m-30b<\/td>\n<\/tr>\n
    Leticia Jackson<\/td>\nRosa Jackson (mother)<\/td>\nJoyce Touchette, Paula Adams<\/td>\nApril 29, 1977<\/td>\nJames R. Randolph<\/td>\nm-31a \u2013 m-31b<\/td>\n<\/tr>\n
    Daren Janaro<\/td>\nRichard Janaro (father)<\/td>\nJoyce Touchette, Debbie Touchette, Laura Johnston<\/td>\nMarch 31, 1977<\/td>\nJames R. Randolph<\/td>\nm-32a \u2013 m-32b<\/td>\n<\/tr>\n
    Gerald Duane Johnson<\/td>\nFlorida Johnson (mother)<\/td>\nJoyce Touchette, Paula Adams, Joicy Clark, Norman Ijames<\/td>\nJune 23, 1975<\/td>\nEnola M. Nelson<\/td>\nm-33a \u2013 m-33b<\/td>\n<\/tr>\n
    James Douglas Johnson<\/td>\nMary A. Johnson (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Margrette Jeffery<\/td>\nApril 9, 1977<\/td>\nMartha E. Klingman<\/td>\nm-34a \u2013 m-34b<\/td>\n<\/tr>\n
    Robert Johnson<\/td>\nRuby Carroll (mother)<\/td>\nJoyce Touchette, Paula Adams, Marceline Jones<\/td>\nNovember 6, 1976<\/td>\nJames R. Randolph<\/td>\nm-35a \u2013 m-35b<\/td>\n<\/tr>\n
    Sharon Denise Johnson<\/td>\nMelvin B. Johnson (father)<\/td>\nJoyce Touchette, Paula Adams, Viola Forks, Mary Lou Clancey<\/td>\nAugust 3, 1977<\/td>\nLisa P. Layton<\/td>\nm-36a \u2013 m-36b<\/td>\n<\/tr>\n
    Kwama R. A. Jones<\/td>\nAnnette T. Jones (mother)<\/td>\nJoyce Touchette, Paula Adams, Viola Forks, Mary Lou Clancey, Dorothy Macon<\/td>\nMay 4, 1977<\/td>\nJames R. Randolph<\/td>\nm-37a \u2013 m-37b<\/td>\n<\/tr>\n
    Lerna Jones<\/td>\nBrenda Jones (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Gary Lee Tyler<\/td>\nApril 1, 1977<\/td>\nMartha E. Klingman<\/td>\nm-38a \u2013 m-38b<\/td>\n<\/tr>\n
    April Klingman<\/td>\nM. Ellen Klingman (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey<\/td>\nApril 1, 1977<\/td>\nJames R. Randolph<\/td>\nm-39a \u2013 m-39b<\/td>\n<\/tr>\n
    Eileen McCann<\/td>\nBette M. McCann (mother)<\/td>\nJoyce Touchette, Paula Adams, Viola Forks, Norman Ijames<\/td>\nJune 9, 1975<\/td>\nEnola M. Nelson<\/td>\nm-40a \u2013 m-40b<\/td>\n<\/tr>\n
    LeAnndra McCoy<\/td>\nCarol A. McCoy (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Christine Bowers<\/td>\nApril 3, 1977<\/td>\nChristine Kice<\/td>\nm-41a \u2013 m-41b<\/td>\n<\/tr>\n
    Lowell McCoy<\/td>\nCarol A. McCoy (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Luella Holmes Brown<\/td>\nApril 1, 1977<\/td>\nChristine Kice<\/td>\nm-42a \u2013 m-42b<\/td>\n<\/tr>\n
    Marcenda McCoy<\/td>\nCarol A. McCoy (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Christine Bowers<\/td>\nApril 1, 1977<\/td>\nChristine Kice<\/td>\nm-43a \u2013 m-43b<\/td>\n<\/tr>\n
    Patty Ann McCoy<\/td>\nCarol A. McCoy (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Christine Bowers<\/td>\nApril 1, 1977<\/td>\nChristine Kice<\/td>\nm-44a \u2013 m-44b<\/td>\n<\/tr>\n
    Raymond McKnight<\/td>\nRose McKnight (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Zipporah Edwards<\/td>\nFebruary 14, 1977<\/td>\nChristine Kice<\/td>\nm-45a \u2013 m-45b<\/td>\n<\/tr>\n
    Michael Javonia Moton<\/td>\nWinifred Moton (mother)<\/td>\nGlen Moton, Viola Moton<\/td>\nAugust 2, 1977<\/td>\nChristine Kice<\/td>\nm-46 \u2013 m-47<\/td>\n<\/tr>\n
    Isaac Jerome Rhodes<\/td>\nRuletta Paul (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Carolyn Looman<\/td>\nJuly 26, 1976<\/td>\nMartha E. Klingman<\/td>\nm-49a \u2013 m-49b<\/td>\n<\/tr>\n
    Marquess Rhodes, Jr.<\/td>\nRuletta Paul (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Carolyn Looman<\/td>\nJuly 30, 1976<\/td>\nMartha E. Klingman<\/td>\nm-50a \u2013 m-50b<\/td>\n<\/tr>\n
    Marvin Wesley Sellers<\/td>\nAlta M. Sellers (mother)<\/td>\nJoyce Touchette, Paula Adams, Tommie Keaton<\/td>\nMay 19, 1977<\/td>\nJames R. Randolph<\/td>\nm-51a \u2013 m-51b<\/td>\n<\/tr>\n
    Mark Andrew Sly<\/td>\nDonald Sly (father)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Sharon Rose Cobb<\/td>\nMarch 15, 1976<\/td>\nChristine Kice<\/td>\nm-52a \u2013 m-52b<\/td>\n<\/tr>\n
    Clark Smith<\/td>\nSylvia Grubbs (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey<\/td>\nApril 2, 1977<\/td>\nChristine Kice<\/td>\nm-53a \u2013 m-53b<\/td>\n<\/tr>\n
    Kelley Smith<\/td>\nSylvia Grubbs (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Luella Holmes Brown<\/td>\nApril 1, 1977<\/td>\nChristine Kice<\/td>\nm-54a \u2013 m-54b<\/td>\n<\/tr>\n
    Kevan Deane Smith<\/td>\nSylvia Grubbs (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey<\/td>\nDecember 14, 1974<\/td>\nJames R. Randolph<\/td>\nm-55<\/td>\n<\/tr>\n
    Stephanie Swaney<\/td>\nDoxsee Swaney (mother)<\/td>\nDebbie Touchette, Paula Adams, Debbie Blakey, Gladys Jackson<\/td>\nApril 1, 1977<\/td>\nJames R. Randolph<\/td>\nm-57a \u2013 m-57b<\/td>\n<\/tr>\n
    Lavonne Thomas<\/td>\nCarolyn Thomas (mother)<\/td>\nJoyce Touchette, Paula Adams, Lugenia Morrison<\/td>\nMay 17, 1977<\/td>\nJames R. Randolph<\/td>\nm-58a \u2013 m-58b<\/td>\n<\/tr>\n
    Cornelius Lee Truss<\/td>\nBarbara Hickman (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey<\/td>\nJuly 27, 1976<\/td>\nLisa P. Layton<\/td>\nm-59a \u2013 m-59b<\/td>\n<\/tr>\n
    Derek Deon Walker<\/td>\nGloria Dawn Walker (mother)<\/td>\nJoyce Touchette, Paula Adams, Farene Douglas, Norman Ijames<\/td>\nMarch 23, 1975<\/td>\nEnola M. Nelson<\/td>\nm-60a \u2013 m-60b<\/td>\n<\/tr>\n
    Darius Wheeler<\/td>\nMarlene Wheeler (mother)<\/td>\nJoyce Touchette, Paula Adams, Debbie Blakey, Corliss Donley Boutte<\/td>\nApril 1, 1977<\/td>\nJames R. Randolph<\/td>\nm-61a \u2013 m-61b<\/td>\n<\/tr>\n
    Burrell Wilson<\/td>\nDeloris Wilson (mother)<\/td>\nJoyce Touchette, Paula Adams, Annette Jones<\/td>\nMay 2, 1977<\/td>\nJames R. Randolph<\/td>\nm-62a \u2013 m-62b<\/td>\n<\/tr>\n
    Ezekiel Wilson<\/td>\nDeloris Wilson (mother)<\/td>\nJoyce Touchette, Paula Adams, Annette Jones<\/td>\nMay 2, 1977<\/td>\nJames R. Randolph<\/td>\nm-63a \u2013 m-63b<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

    [Page 5] PARENTAL CONSENT AND POWER OF ATTORNEY STATE OF CALIFORNIA COUNTY OF SAN FRANCISCO UNITED STATES OF AMERICA I, [name], hereby declare: I am the natural _____ [mother or father]\/legal guardian\/of _____ [name of minor], a minor, born _____ [birthdate]. I hereby consent to said minor going to Guyana, South America, to live and […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":94442,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-129417","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/pages\/129417","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=129417"}],"version-history":[{"count":4,"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/pages\/129417\/revisions"}],"predecessor-version":[{"id":131549,"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/pages\/129417\/revisions\/131549"}],"up":[{"embeddable":true,"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=\/wp\/v2\/pages\/94442"}],"wp:attachment":[{"href":"https:\/\/jonestown.sdsu.edu\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=129417"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}