Fillable Application To Visit An Inmate printable pdf download

ARIZONA DEPARTMENT OF CORRECTIONS

Important: Mail the completed form directly to the Unit Visitation Office where the

inmate is located. Envelope must clearly state: Attention Visitation Officer.

Application to Visit an Inmate

If including the $25.00 Background Check Fee, the envelope must clearly state:

Attention Visitation Officer-Background Check Fee. Do not mail the

application or fee directly to the inmate; we must receive it from you or it will

(Check one)

be voided.

Note: Must complete both sides of application. By completing and

Phone Calls Only

(No fees)

submitting this form you are attesting to the truthfulness and accuracy of the

information.

Phone and In Person

(Fee applies)

The inmate named below has requested that you be added to his/her visiting list. If you want to visit this inmate, please complete the

Visitor Information Section. If this application is for a child under the age of 18, you must also provide the name of a parent or other adult

who will accompany the child, and who must sign this application form. A SEPARATE APPLICATION MUST BE COMPLETED FOR

EACH PROPOSED VISITOR (ADULT OR CHILD).

It is important to complete both sides of this application and answer all related questions truthfully, failure to do so will result in

automatic disapproval. All of the material will be considered confidential and the inmate will be notified whether the application

is approved or disapproved. *It is recommended all visitors review DO 911, Inmate Visitation prior to completing application.

Institution/Facility

ADC Number

Inmate Name

(Last, First M.I.)

Visitor Information Section

Adult - $25.00 Money Order Included, Payable to Arizona Department of Corrections - Visitation

Adult - Prior Background Check Fee paid on

Minor - Background Check Fee Waived

Exempt - Per DO 911

Date

Aliases or other names used

Visitor Name

(include maiden name if married)

(Last, First M.I.)

Minor's Parent or Legal Guardian Name

Minor's Parent or Legal Guardian Date of Birth

(Last, First M.I.)

Residential Address

City

State

Zip Code

(Street)

Home Telephone Number

City

State

Zip Code

(

)

I WILL accept phone calls from this inmate

Mailing Address

(collect or other)

(If different than residential address)

Yes

Date of Birth

Place of Birth

Driver's License Number or other Photo ID Number

Weight

Height

Eye Color

Gender (M/F)

Ethnicity

Employer's Name

Employer's Telephone No.

Job Title

(

)

City

State

Zip Code

Employer's Address

What is your relationship with the inmate?

(Check one)

Husband

Step-Father

Brother

Uncle

Other Relative

Wife

Step-Mother

Sister

Aunt

Not Related

Father

Grandfather

Son

Nephew

Mother

Grandmother

Daughter

Niece

It is the policy of the Arizona Department of Corrections to comply in all respects with the requirements of the Americans With Disabilities Act and Section

504 of the Rehabilitation Act of 1973. Persons with a disability may request a reasonable accommodation such as a sign language interpreter, by

contacting the Institution where the inmate is assigned. Requests should be made seven day in advance to allow time to arrange the accommodation.

This document available in alternate format by contacting the Arizona Department of Corrections Central Office Communications.

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Application To Visit An Inmate

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