|
Visitor’s Request Form |
RETURN FORM TO: |
BACK MUST BE SIGNED |
Unit Manager/Unit ___________ |
_______________________ |
DO NOT RETURN TO INMATE OR IT WILL BE REJECTED
________________________________________________ |
_______________________________________________ |
Inmate Name |
ODOC Number |
PLEASE PRINT ALL INFORMATION – EVERY SPACE MUST BE FILLED
A copy of your driver’s license or state issued identification card must be submitted with this request.
Visitor’s Last Name:_________________________First Name:_________________________Middle Initial:________
Your Date of Birth:______________________ Your Place of Birth:____________________________________________
(MM/DD/YY) |
|
|
(City, State) |
Your SSN: ______-_____-_____ |
Gender: _______ |
Race: _______ Height:: |
_______ Weight: ______ |
Street Address:________________________________________________________Phone Number:________________ |
Mailing Address:___________________________________________________________________________________ |
City:___________________________ |
State:__________________________ |
Zip Code:_______________________ |
Your Occupation:__________________________________ |
Employer’s Name:________________________________ |
Employer Address & Phone Number:____________________________________________________________________ |
Your Relation to Inmate:___________________________ |
How long have you known inmate?__________________ |
Have you or a family member ever been employed by the Oklahoma Department of Corrections (ODOC), Private Prisons,
or previously been an ODOC/PPA volunteer? |
Yes |
No If yes, when? |
Are you currently corresponding/volunteering or visiting with any other inmate(s) incarcerated in the State of Oklahoma?
Yes |
No |
Relationship: ____________________________________________________________________ |
If yes, Inmate’s Name and ODOC Number:___________________________________________________________
Where: _____________________ When:__________________ Charge: _______________________________
Are You Married? |
Yes |
No Date of Marriage:_________________ State:__________________________ |
Spouse’s Name:___________________________________ |
Spouse’s Date of Birth:_____________________________ |
Spouse’s Occupation:______________________________ |
Spouse’s Employer Name:__________________________ |
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|
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Have you ever been arrested or charged for any crime or complaint? |
Yes |
No |
|
If yes, please list below the following information (if more space is needed, please attach another sheet of paper): |
Date of Arrest |
|
County, State |
|
Nature of Charge |
Disposition/Outcome |
________________________________________________________________________________
________________________________________________________________________________
Have you ever been suspended from visiting any inmate incarcerated by the Oklahoma Department of Corrections
If yes, give dates, facility and circumstances for the suspension: ______________________________________________
_________________________________________________________________________________________________
Page 1 of 3
DOC 030118B
If you are on Probation or Parole, you must seek approval from your Probation/Parole Officer to visit with inmate. The warden of this facility will approve or deny visiting privileges.
Has any member of your family (other than inmate above) ever been incarcerated at a penal institution? |
Yes |
No |
If yes, Name and Relation: ___________________________________________________________________________
Where: ________________________When: ___________________ Charge: ___________________________________
Make/Model of Your Automobile: ____________________________________Tag Number: ________________________
Your Driver’s License Number: _______________________________ State: ____________ Expiration Date:__________
A copy of your driver’s license or state issued identification card must be submitted with this request.
PLEASE READ THE RULES AND REGULATIONS BELOW
All visitors 18 years of age and older must have bonafide identification which includes their photograph when visiting any facility. State driver’s licenses, state, federal, military or school I.D.’s are acceptable. For those who do not drive, acceptable identification cards can be obtained from the local offices of the Oklahoma Department of Motor Vehicles for a nominal fee. Correctional staff will not permit anyone to enter without identification as indicated.
Under Oklahoma Statutes, Title 57, Chapter 1, Statute 21: Any person who, without authority, brings into or has in his or her possession in any jail or state penal institution or other place where prisoners are located, any gun, knife, bomb, or other dangerous instrument, any controlled dangerous substance as defined by Section 2-201 et seq. of Title 63 of the Oklahoma Statutes, any intoxicating beverages or low-point beer as defined by Sections 163.1 and 163.2 of Title 37 of the Oklahoma Statutes, money, or financial documents for a person other than the inmate or a spouse of the inmate, including but not limited to tax returns, shall be guilty of a felony and is subject to imprisonment in the custody of the Oklahoma Department of Corrections (ODOC) for not less than one (1) year or more than five years, or a fine of not less than One Hundred Dollars ($100.00) or more than One Thousand Dollars ($1,000.00), or both such fine and imprisonment. Any person who, without authority, brings into or has in his or her possession in any jail or state penal institution or other place where prisoners are located, cigarettes, cigars, snuff, chewing tobacco, or other form of tobacco product shall, upon conviction, be guilty of a misdemeanor punishable by imprisonment in the county jail not to exceed one (1) year or by fine not exceeding Five Hundred Dollars ($500.00), or both by such fine and imprisonment. Any person knowingly, willfully and without authority brings into or has in his or possession in any secure area of a jail or state penal institution or other secure place where prisoners are located any cellular phone or electronic device capable of sending or receiving any electronic communication shall, upon conviction, be guilty of a felony punishable by imprisonment in the custody of the Oklahoma Department of Corrections (ODOC)for a term not exceeding two (2) years, or by fine not exceeding Two Thousand Five Hundred Dollars ($2,500.00), or by both such fine and imprisonment.
Where there exists a reasonable suspicion or probable cause to believe that a particular visitor is attempting to introduce contraband into this institution, the warden/facility head or his designee may order that the visitor be subjected to a more thorough search. A visitor may be requested to submit to a strip search only when the warden/facility head or his/her designee determines there is probable cause to believe the particular visitor possesses contraband. In such an instance, the search must be conducted by two trained staff members of the same gender as the visitor. The visitor may also be subject to search by a certified drug dog. Any attempt to interfere or interact with the canine will be grounds for termination of the visit.
Everyone entering the perimeter of this facility will, at a minimum, be subject to a pat search. Bags, purses, boxes, etc., carried by persons entering this facility will be subject to search. All vehicles and their contents are subject to search upon entering the grounds.
Should a visitor refuse to grant permission for the search, entry to the facility will be denied and may be grounds for appropriate action. In addition, the person will be denied future access to the facility.
CONSENT TO SEARCH/ACCESS TO CRIMINAL HISTORY INFORMATION
I, THE UNDERSIGNED, DO HEREBY ACKNOWLEDGE THAT I UNDERSTAND AND I AM SUBJECT TO THE LAWS OF THE STATE OF OKLAHOMA AND REGULATIONS OF THE OKLAHOMA DEPARTMENT OF CORRECTIONS (ODOC) WHILE ON THE PROPERTY OF THE CORRECTIONAL FACILITY. I UNDERSTAND THAT MY ENTRY ONTO PRISON GROUNDS IS PRESUMED CONSENT TO A PAT DOWN SEARCH AND THE SEARCH OF MY VEHICLE AND THAT MORE INTRUSIVE SEARCHES MAY OCCUR, DEPENDING UPON THE FACTS AND SUSPICIONS KNOWN TO PRISON STAFF. I FURTHER UNDERSTAND THAT BY MY SIGNATURE BELOW, I AM AUTHORIZING THE OKLAHOMA DEPARTMENT OF CORRECTIONS (ODOC) TO CONDUCT A CRIMINAL BACKGROUND CHECK.
Page 2 of 3
DOC 030118B
Your signature below indicates you have read, or have had read to you and understand, the rules outlined in the “Visitor’s Request Form” and the “Visitor’s Rules of Conduct/Violations/Sanctions” form:
Name:
____________________________________________________________________________________________
(Print or Type)
Your Signature:_______________________________________________________ Date: ________________________
IF YOU ARE UNDER EIGHTEEN (18) YEARS OF AGE, YOU MUST HAVE YOUR PARENT’S OR LEGAL GUARDIAN’S SIGNATURE OR THIS REQUEST WILL BE DENIED.
Parent/Guardian Printed Name:____________________________________________________________________
Parent/Guardian Phone
Number:_______________________________________________________________________________________
Parent/Guardian Signature:_______________________________________________ Date: _______________________
ANY INDIVIDUAL WHO FALSIFIES INFORMATION OR PURPOSEFULLY OMITS INFORMATION ON THIS VISITING FORM WILL BE DENIED VISITATION PRIVILEGES AND MUST WAIT 90 DAYS TO REAPPLY.
A copy of your driver’s license or state issued identification card must be submitted with this request.
Official Use OnlyAPPROVED _____________________ DENIED ________________________
Has the IGI Database and sections 4 and 6 of the field file been checked to verify any visitation restrictions/suspensions?
Yes |
No |
|
Has OMS and the Inmate Visitation Card been checked to verify any visitation restrictions/suspensions? Yes |
No |
Page 3 of 3
DOC 030118B (R 06/21)
