INTERSTATE COMPACT FOR JUVENILES 

  FORM III 

 CONSENT FOR VOLUNTARY RETURN OF OUT OF STATE JUVENILE 

I, 

I, 

I, 

(Juvenile’s Name)

, acknowledge that I legally belong with 

in 

 (Legal Guardian or Custodial Agency seeking return) 
and I voluntarily consent to return without further legal proceedings, either by  myself  or in the company of such 
person(s) as the appropriate authority may appoint for that purpose. 

(City)                             (State) 

(Date) 

(Juvenile’s signature) 

(Judge’s Name) 

 
having informed the juvenile named above of 
prior to the execution of the foregoing consent, do hereby find that the voluntary return of said juvenile to: 

 her rights under the Interstate Compact for Juveniles  

                                                     (Court or Jurisdiction) 

 his   

, Judge of 

(Legal Guardian or Custodial Agency seeking return) 

(Contact name & phone number) 

is appropriate and in the best interest of said juvenile, and do so order such return.  

in 

  (City) 

    (State)

(Date) 

(Judge’s signature) 

============================================================================================
TO BE COMPLETED ONLY IF COUNSEL OR GUARDIAN AD LITEM IS APPOINTED (Optional): 

attest that I have consulted with the juvenile regarding his/her decision to voluntarily return to: 

being the  Counsel   Guardian Ad Litem of 

(Name of Juvenile) 

(Legal Guardian or Custodial Agency seeking return)

(City)

(State) 

in 

 (Date) 

(Signed - Counsel or Guardian Ad Litem) 

(Form will be certified or authenticated in accordance with practice of the court.) 
Original:  Court  file;  1  copy  each:  Juvenile,  Holding  State’s  Compact  Administrator,  Home/Demanding  State’s  Compact 
Administrator, Local Court in Demanding State. 
============================================================================================ 
DETAILED PHYSICAL AND CLOTHING DESCRIPTION OF JUVENILE, & CONTACT INFORMATION 

Sex: 

  Ht.:

Wt.:         

Eye color: 

DOB: 

Race: 

Hair color and style: 

Tattoos, scars, identifying marks: 

Clothing (including shoes): 

Juvenile's Physical Location in Holding State:  

ICJ FORM III  |  Rev. 11-14-16