Adult Correctional Facility Visiting Program Application Form
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2ADULT CORRECTIONAL FACILITY VISITING PROGRAM APPLICATION
ATTENTION:
•
All visitors are subject to a security check and criminal record name check.
•
An application may be denied if security and safety concerns are present (based on the results of the security
screening process).
•
All visitors may be searched in accordance with Part IV, Division IV of The Correctional Services Act, 2012.
•
All visiting activities will be monitored and may be supervised.
•
Once an application is approved, the application is valid for the duration of the inmate’s current sentence unless new
information requires further review.
•
Only one application is required from a person who applies to visit with more than one “immediate family member”
who is incarcerated in the same correctional facility.
Inmate Information: (Please print the name of the inmate(s) you want to visit)
Family Name
Given Name(s)
Correctional Facility
1.
2.
3.
Relationship with inmate:
I am the inmate’s______________________________________________________________________________
Please specify relationship and length of relationship where appropriate
Applicant Information: (Please print your name and information)
Family Name
Given Names (full)
Maiden Name
Date of Birth
(if applicable)
___/___/_____
DD / MM / YYYY
Your current address:
Telephone Number:
Give the name and the date of birth of any of your children below age 18 for whom you wish to have visiting privileges.
Please note that the child visiting the correctional facility MUST be accompanied by the child’s legal guardian :
(i)
Name:____________________________________/DOB _______/_______/_______
(ii)
Name:____________________________________/DOB _______/_______/_______
(iii)
Name:____________________________________/DOB _______/_______/_______
(iv)
Name:____________________________________/DOB _______/_______/_______
(v)
Name:____________________________________/DOB _______/_______/_______
DD
MM
YYYY
Applicant’s Declaration and Consent
I hereby declare that to the best of my knowledge the information in this application is true and complete. I understand
I must immediately report any changes in my circumstances that affect my eligibility for the Correctional Facility Visiting
Program.
I hereby consent to the collection, use and/or disclosure of any information I have provided about me to and from an
offi cial of the Ministry of Justice which will be used exclusively to perform a criminal record check on me, based on the
information provided. I understand that approval of visiting privileges is conditional upon satisfactory results of a criminal
record check.
The information is being collected, used and disclosed in accordance with accepted collection, use and disclosure of per-
sonal information as defi ned in The Freedom of Information and Protection of Privacy Act and will be relevant to, and may
be used, shared or disclosed for the purpose of determining and verifying my eligibility as a visitor in a correctional facility
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