Appendix 4.1A: Authorization for Common Fare Participation
Name of Detainee:
I hereby request authorization to participate in the Common Fare Program. I agree to comply with the program requirements. I understand that if I am observed consuming mainline foods or violating other program requirements, I may be removed from program participation and will not be eligible for immediate reinstatement. Repeated program violations may result in removal from the program for up to one year. I further understand that the same conditions for reinstatement may apply if I voluntarily withdraw from the program for any reason.
I understand that I must have a recorded religious preference in order to be eligible for the program and that I must provide a written reason for requesting to participate in the religious diet program.
Religious preference: ___________________________
Specific reason for wanting to participate in the Common Fare Religious Diet Program:
Signature of detainee: ___________________________
Signature of chaplain: ___________________________
Record Copy – Detainee Detention File; Copy – Chaplaincy Office; Copy – Detainee