COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC. Gallatin County Re-Entry Program SPONSOR FORM Name of Resident Being Sponsored: Name of Sponsor Applicant: Community passes are one of the most important privileges that residents of CCCS, Inc. can earn during the course of their residency within the pre-release center. These passes are used as a tool for the individual resident to re-establish or maintain their supportive relationships with either family or friends. In order for program staff to be able to provide appropriate levels of accountability of center residents while they are in the community, an approved sponsor is necessary to oversee and verify scheduled pass activities. Each resident will be allowed: Unlimited Family Sponsorship 1 Male Sponsor 1 Female Sponsor 1 AA Sponsor (male) As a condition of a resident being granted the privilege and opportunity of taking community passes, the approved community sponsor must agree to the following: 1. I hereby agree to verify and account for the resident s whereabouts and activities while on an approved community pass. I agree to remain with the resident throughout the entire duration of the pass. 2. I understand that program staff will be conducting ongoing security checks during the course of any community pass. These checks are inclusive of, but not limited to: a. Phone Checks b. On-site visits c. Requiring that the resident physically report back to the pre-release center midway through his community pass. 3. I agree to be open and honest with CCCS, Inc. staff and will immediately inform center staff if the resident violates any of the conditions of his pass. By signing this sponsor agreement form, I understand the above and will accept the responsibilities of sponsorship as defined above. Sponsor Signature Staff Witness
COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC. Gallatin County Re-Entry Program AUTHORIZATION TO CONDUCT AN N.C.I.C. RECORDS CHECK (National Crime Information Center) I hereby authorize the identification Bureau of the Department of Justice, State of Montana, to run an N.C.I.C. records check on my background and also authorize the release of the results of said records check to the staff of Community, Counseling & Correctional Services, Inc. I further wish to freely waive my right to any federal or state statutes protecting privileged information and authorize disclosure of said information to CCCS, Inc. I also understand that it is the policy of Community, Counseling & Correctional Services, Inc. to run background checks on all prospective visitors/sponsors for any of the residents within those community-based correctional facilities operated by CCCS, Inc. I also understand that the records check must be completed before any consideration will be given to my request to act in the capacity as an approved community visitor/sponsor. d this day of, 20 Applicant s complete & full legal name (printed) Applicant s complete & full signature Applicant s Social Security Number - - Applicant s of Birth Name of Resident CCCS, Inc. Staff Signature & Title COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC. Gallatin County Re-Entry Program
VISITOR-SPONSOR APPLICATION Resident Name Applicant Name (full & complete) Relationship to Resident Sex Male Female Current Address Street City State Zip Land Line of Birth / / Age SS# Cell Phone Height Weight Hair Color Eye Color Please answer the following questions Are you currently under formal supervision (probation/parole)? Yes No If Yes, please provide the name of your supervising officer and the city in which you are under supervision Have you ever been arrested? Yes No If yes, please state the year of your most recent arrest and the offense(s) you were charged with The following questions are for non-family members only : How long have you known the resident you wish to sponsor? Where, when & how did you meet him? As a condition of your sponsorship/visitation, it is required that an interview be conducted by a staff member of CCCS, Inc. prior to the approval of your status as a community sponsor/visitor. It is further required that a N.C.I.C. (National Crime Information Center) Records Checks be completed. Sponsorship and/or visitation will not be allowed until such time as this background check is completed. Exceptions are allowed in the case of parents, grandparents or pre-approval from either the state or federal penal system.
COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC VOLUNTEER RESPONSIBILITY WAIVER Volunteer Driving Resident(s) to: (check applicable box) Work Church Community Service Other I,, hereby release Community, Counseling & Correctional Services, Inc. from any responsibility due to any accident that occurs to my self while I am transporting any resident currently housed in any of the community-based correctional programs operated by CCCS, Inc. I further understand that insurance for my own personal vehicle is my responsibility while I am transporting any resident of the Gallatin County Re-Entry Program. I also understand that in the event of an accident while I am transporting a program resident of CCCS, Inc., it will be my insurance company s responsibility to absorb any and all liability for damages that my be incurred as the result of such and accident. I also agree that for no reason will I allow or authorize any resident currently housed within any of the community-based programs currently operated by CCCS, Inc. to operate (drive) my personal vehicle(s). I also agree that no resident of these same programs will be allowed the use of my personal vehicle. I also agree to furnish the staff of CCCS, Inc. with a valid Montana State Driver s License, proof of insurance and current vehicle registration before I transport any program resident in my personal vehicle. Resident s Name Sponsor Signature Staff Witness
VEHICLE INFORMATION Make Color Model Year License Plate Number & Expiration Valid Driver s License verified and copied? Yes No Staff Initials: Valid Vehicle Registration verified and copied? Yes No Staff Initials: Valid Car Insurance verified and copied? Yes No Staff Initials: ADDITIONAL VEHICLE INFORMATION Make Color Model Year License Plate Number & Expiration Valid Driver s License verified and copied? Yes No Staff Initials: Valid Vehicle Registration verified and copied? Yes No Staff Initials: Valid Car Insurance verified and copied? Yes No Staff Initials: If you answered No to any of the above, please provide explanation:
*ATTACH COPIES OF LICENSE, REGISTRATION & INSURANCE TO THIS FORM AND PLACE IN ASSIGNED CASE MANAGER S MAILBOX* Listed below are the requirements and regulations of this program applied to potential visitors and/or sponsors for residents of CCCS, Inc. 1) At the time sponsorship application and/or receipt of an application by mail, the potential visitor/sponsor must be able to produce a valid, picture identification or the application will not be processed. 2) Potential sponsors/visitors must be cleared by a National Crime Information Center Records Check. This is inclusive of everyone except the parents and grandparents of the resident. 3) All sponsors/visitors must be at least 18 years of age. However, if they are still enrolled in high school, they must submit a notarized letter from a parent/guardian indicative of approval of sponsorship. 4) While on a community pass, program residents are strictly forbidden from using, purchasing or possessing alcohol or illegal drugs. Program residents are also prohibited from being in the company of approved sponsors/visitors who choose to ingest alcohol and/or drugs while accompanying program residents during community passes. 5) Residents are strictly forbidden from entering any establishment where alcohol is the chief item for sale. They are allowed in casino-type restaurants as long as the residents remain in the restaurant section of the facility. 6) Program residents are not allowed to participate in any type of gambling during the entirety of their placement within the community- based program to which they are assigned. 7) When program residents return from a community pass, they must submit a urine sample to Re-Entry Program staff for appropriate screening for the presences of alcohol and/or drugs. 8) Program residents must remain in the company of their approved community sponsor at all times while on an approved community pass. 9) Program residents are strictly forbidden from operating any motor vehicle while on a community pass. 10) Program residents are restricted to the boundaries of Gallatin County while on community pass. 11) Approved sponsors must come into the community-based facility in order to pick-up the resident being signed out of the facility for community pass purposes. Approved sponsors must also physically escort the resident back into the Re-entry facility at the conclusion of the pass. 12) Sponsors/visitors are required to maintain adequate supervision over any juveniles that may be in their company. 13) The GCRP will not be held liable for lost or stolen goods of a sponsor/visitor. 14) Prior to a resident of CCCS, Inc. being allowed to go to a pass location in Gallatin County, a member of the CCCS staff must conduct an on-site visit of said location for approval. 15) Residents must call from a landline phone when at their primary location on community pass as well as each location. Cell phone calls will not be accepted as a means of checking in with location. 16) Residents are to follow center rules and schedule. If any conflict or situation should arise, the resident must speak with a Case Manager or the Shift Supervisor to approve a location and/or schedule change. 17) Any approved sponsor/visitor who arrives at the Gallatin County Re-Entry Program to pick-up a resident for pass and are suspected to be under the influence of any intoxicating agent will be immediately asked to leave the premises and will be terminated as a sponsor/visitor 18) Sponsor assumes responsibility for providing staff with updated information pertaining to changes in their driver s license, insurance, registration or vehicle information. Sponsors must provide information for each and every vehicle they will be operating while transporting residents. If at any time any of the above information is not supplied, the resident will be denied going on community pass until such information is supplied to staff. PLEASE NOTE: ALL ITEMS BROUGHT INTO THE RE-ENTRY PROGRAM ARE SUBJECT TO SEARCH BY STAFF.
I understand and agree to abide by all the conditions and terms outlined above: Sponsor Signature Staff Signature COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC In-House Visiting Rules & Regulations Visitation Dress Code This code applies equally to men, women, and all children aged 7 and above. All visitors must be dressed in a manner that will not distract, disrupt, disturb and/or be offensive to other visitors, residents, or staff on Gallatin County Re-Entry Program property. Decisions in this matter will be made by front receiving office staff. If the visitor has a question about the decision, it will be referred to the shift supervisor or to the Chief of Security. If, in their estimation, the clothing is not appropriate, the visitor will be asked to leave. The visitor will not be allowed a wrap to cover the problem in question. He or she must leave the facility upon staff request. The articles of clothing listed below are prohibited while on Re-Entry program property. Spandex tops or pants Short-shorts Transparent clothing (any visibility through a top, skirt, or pants) Clothing without the proper undergarments (bra, slip, and/or underwear) Any skirt of dress higher than 2 above the knee All shirts and tops must cover the midriff area at all times Hats, caps or head scarves Tank-type tops are not allowed as an outer garment. All tops, shirts or blouses must have sleeves. Said items must be worn with a bra (females) and must not be excessively low cut or revealing. Any article of clothing (except coats) worn into the facility may not be taken off when visiting. Purses, backpacks, diaper bags, cameras and cases, video cameras and cases, laptops and cases, and all other forms of baggage/luggage are prohibited. Visitors who have young children are allowed to bring in up to 3 diapers, a small container of wipes and 2 bottles. BASIC RULES, REGULATIONS, AND EXPECTATIONS Disability Accommodation: If you have a health problem, injury, or physical or mental disability and are needing assistance or accommodation in entering any of our facilities, please contact: Chief of Security, Jessica Graham, (406) 994-0300 X 1114 or email her at jgraham@cccscorp.com. Visiting hours are from 1:00-3:45 PM on Saturdays and from 3:00-5:45 PM on Sundays. You must call (406) 994-0300 (24 hours in advance) to schedule a visit and be an approved sponsor or direct family. Direct family is defined as spouse, parents and grandparents, and children under age 18. Girlfriends and fiancées are not considered direct family and thus, must be approved sponsors. If children are visiting and are under the age of 18, they must be accompanied with an approved sponsor. All visitors must sign in at the front office with staff before entering the facility. Approved visitation areas are the Treatment room and the Dining room. While visiting in the Treatment room the doors are to remain open at all times. No outside food or drink is to be brought into the facility at any time. Visitors are not permitted to smoke on GCRP property. Any inappropriate conduct during visitation will result in a write-up for the resident and loss of visitation privileges for the visitor. A brief embrace is allowed when your visitor arrives and departs. All items brought into the facility as well as visitors are subject to search at any time while in the facility. If alcohol or drug use is suspected, you will be asked to leave the facility grounds immediately and loss of visitation privileges will occur. Special visits will be approved only by the Chief of Security or the Director of the Gallatin County Re-Entry Program. PLEASE NOTE: ALL ITEMS BROUGHT INTO THE RE-ENTRY PROGRAM ARE
SUBJECT TO SEARCH BY STAFF. I understand and agree to abide by all the conditions and terms outlined above: Sponsor Signature Staff Signature