Form Dc 313 – Fill Out and Use This PDF

(DC-313 – Visitor Inquiry)

COMMONWEALTH OF PENNSYLVANIA Department of Corrections SCI-___________________

_______________________

Attention: Counselor __________________

Requesting Inmate Name/Number: _________________________ Housing Unit: ___________

(Minor should be listed on current visiting list)

Minor’s Name: _________________________ Date of Birth: ________ Gender: M □ F □

Relationship: □ Son □ Daughter □ Grandson □ Granddaugher □ Niece □ Nephew □ Other ________

Minor’s Parent/Guardian: ________________________________________________________

____________________________________________________________________________

Address: StreetCity State Zip

The inmate named above has requested that (Minor’s Name) ___________________________

Be approved as an authorized visitor and be permitted to visit him/her at the above facility.

Department of Corrections policy requires that the parent or legal guardian of a minor child (including a child of the inmate) submitted for Visiting List approval, be notified of such a request. The parent or legal guardian must indicate in writing that he/she approves of or objects to the minor visiting the inmate. The parent or legal guardian may also approve an adult to accompany the minor on such a visit(s).

Please indicate your decision by checking the appropriate box or boxes below:

□I object to having the above named minor on the inmate’s Visiting List.

□I approve of having the above named minor on the inmate’s Visiting List.

□I approve the adult listed below to accompany the minor on visit(s).

_______________________________________________________

Signature of Parent or Legal GuardianDate

Please return this inquiry to the above address. If your reply is not received within two weeks, the inmate’s request will be disapproved. The institution must receive this form no later than: ______

___________________________________________________________________________________

Unit Manager or Counselor’s Signature and Date form returned.

DC-ADM 812, Inmate Visiting Privileges Procedures Manual

Section 1 – General Procedures

Attachment 1-A

Issued: 3/31/2014

Effective: 5/1/2014

(DC-313A – Special Visitor Inquiry)	COMMONWEALTH OF PENNSYLVANIA
	Department of Corrections
(One Minor per form)	SCI--_____________________________
	_________________________________
	_________________________________
	Attention: Counselor ____________________

Requesting Inmate Name/Number: ______________________________ Housing Unit: _____________

(Minor should be listed on current visiting list)

Minor’s Name: ___________________________________ Date of Birth: ________ Gender: □ M □ F

Relationship: □ Son □ Daughter □ Grandson □ Granddaugher □ Niece □ Nephew □ Other ________

Minor’s Parent/Guardian: _______________________________________________________________

___________________________________________________________________________________

Address: StreetCity State Zip

The above referenced inmate has requested that (Minor’s Name) _______________________________

be approved as an authorized visitor and be permitted to visit him/her at the above facility.

Department of Corrections policy requires that the parent or legal guardian of a minor child (including a child of the inmate) submitted for Visiting List approval, be notified of all charges that the inmate is, or was previously incarcerated for when those charges resulted from any physical or sexual abuse of a minor. The parent or legal guardian must indicate in writing that he/she is aware or the charges against the inmate and that he/she approves of or objects to the minor having a non-contact visit with the inmate, and indicate whether the minor was or was not a victim of the inmate. The parent or legal guardian may also approve an adult to accompany the minor on a visit(s).

The charges against the inmate are: ______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Please indicate your decision by checking the appropriate boxes below:

□I, being made aware of the charges against this inmate, object to having the above named minor on the inmate’s Visiting List.

□I, being made aware of the charges against this inmate, approve of having the above named minor on the inmate’s Visiting List.

□I approve of having the minor’s adult family member(s) (listed below) accompany the minor on visit(s).

□ The Minor was a victim of the inmate.	□The Minor was not a victim of the inmate.
___________________________________________________
Signature of Parent or Legal Guardian	Date

Please return this inquiry to the above address. If reply is not received within two weeks, the inmate’s request will be disapproved. The institution must receive this form no later than: __________________

_______________________________________________________________________________________

Unit Manager or Counselor’s Signature and Date form returned.

DC-ADM 812, Inmate Visiting Privileges Procedures Manual
Section 1 – General Procedures	Attachment 1-B

Issued: 3/31/2014

Effective: 5/1/2014