© Clark County Family Law Self-Help Center Consent to Child’s Name Change (Parent) – Jan. 2015
* You are responsible for knowing the law about your case. For more information on the law, this form, and free
classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find
an attorney, call the State Bar of Nevada at (702) 382-0504.
1
CONS
Your Name: ________________________
Address: ___________________________
City, State, Zip: _____________________
Phone: ____________________________
Email: ____________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
(Parent’s name)
_________________________________
For Change of Name of the Minor Children:
(First child’s current name)
_________________________________
and (Second child’s current name or “N/A”)
_________________________________
CASE NO.: ____________________
DEPT: _____________________
CONSENT TO NAME CHANGE (PARENT)
I, (consenting parent’s name) __________________________________________, the
( check one) mother / father of the above-named minor child(ren), give my full and free
consent to change (first child’s current name) ______________________________________’s
name to (first child’s new name) ___________________________________ and to change
(second child’s current name or “N/A”) _______________________________________’s name
to (second child’s new name) ________________________________________.
THIS FORM MUST BE SIGNED IN FRONT OF A NOTARY.
Once you complete the form, print it out and sign it in front of a notary. The parent's original signature and the
notary's stamp and signature must appear on the document that is filed with the court.
