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 ___________________  (Mom and/or Dad) 

that should I break this curfew on ________________________  (date of event)  that I will  _____________
 
______________________________________________  (punishment for breaking curfew).     

I understand and agree that I will also need  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.
  
 
 
 
 
______________________________         ____________________________             _________
    Child’s Signature                                     Parent’s Signature                                    Date