Consent to Search Form Rev 010114.pdf

AR Form 300-27C (01/01/14)

STATE OF COLORADO

DEPARTMENT OF CORRECTIONS

CONSENT TO SEARCH AUTHORIZATION

AND REGISTRATION

A. UNDER THE PROVISIONS OF COLORADO LAW, THE FOLLOWING ITEMS ARE DECLARED

CONTRABAND TO THE OFFENDER POPULATION. VISITORS SHALL NOT INTRODUCE OR ATTEMPT TO INTRODUCE THESE ITEMS INTO THIS FACILITY/OFFICE OR AT ANY LOCATION WHERE AN INMATE IS LIKELY TO BE LOCATED WHILE SUCH INMATE IS IN THE CUSTODY AND UNDER THE JURSDICTION

OF A POLITICAL SUBDIVISION OF THE STATE OF COLORADO OR THE DEPARTMENT OF

CORRECTIONS, BUT NOT ON PAROLE.

1. Any dangerous instrument: A firearm, explosive device or substance (including ammunition), knife or sharpened instrument, poison, acid, bludgeon, or projective device, or any other device, instrument, material, or substance which is readily capable of causing or inducing fear of death or bodily injury, the use of which is not specifically authorized.

2. Alcoholic beverages.

3. Controlled substances.

4. Any key, key pattern, key replica, or lock pick.

5. Any tool or instrument that could be used to cut fence or wire, dig, pry, or file.

6. Any money or coin of United States or foreign currency or any written instrument of value.

7. Any un-canceled postage stamp or implement of the United States postal service.

8. Any counterfeit or forged identification card.

9. Any combustible material

10. Any drug, other than a controlled substance, in quantities other than those authorized by a physician.

11. Any mask, wig, disguise, or other means of altering normal physical appearance which could hinder ready identification.

12. Any drug paraphernalia: all equipment, products, and materials of any kind which are used, intended for use, or designed for use in planting, propagating, cultivating, growing, harvesting, packaging, repackaging, storing, containing, concealing, injecting, ingesting, inhaling, or otherwise introducing into the human body a controlled substance in violation of the laws of this state.

13. Any material which is “obscene.”

14. Any chain rope or ladder.

15. Any cigarettes or tobacco products.

16. Any portable electronic communication device including but not limited to cell phones, public, private or family style radios, pagers, personal digital assistants, any other device capable of transmitting or intercepting cellular or radio signals, and portable computers; except those devices authorized by the executive director of the DOC.

17. Any article or thing that poses or may pose a threat to the security of the DOC facility/office as determined by the Administrative Head of the facility/office. This shall include but not be limited to: matches, cigarette lighters, any substances used for brewing or making intoxicating beverages, any counterfeit or forged medium of exchange, or paraphernalia used to produce this medium, any written message, item or object that is to be sent or brought to another offender, batteries, cameras, film, flashbulbs, flashlights, chewing gum, pets, plant life, or any article or substance that is not specifically allowed by facility/office procedures.

AUTHORITY

CRS 12-22-203 CRS12-22-303 CRS 12-46-103 CRS 12-47-103

CRS 18-7-101 CRS 18-8-203, 204, 204.1, 204.2 CRS 18-18-102

CRS 18-18-202 thru 207 CRS 18-18-426

B. PENALTIES:

ANYONE VIOLATING SECTION A MAY BE BARRED FROM THE FACILITY AND MAY BE SUBJECT TO

CRIMINAL PROSECUTION

Attachment “C”

AR Form 300-27C (01/01/14)

C. DECLARATION OF CONSENT AND WAIVER

AS A CONDITION OF ENTERING THE PROPERTY OF COLORADO DEPARTMENT OF CORRECTIONS, I

HEREBY CONSENT TO ANY SEARCH OF MY PERSON AND/OR ANY OF MY PERSONAL PROPERTY, OR

OF THE PERSON OF ANY MINOR CHILDREN ACCOMPANYING ME OR OF ANY VEHICLE THAT I MAY

BRING ON THE GROUNDS OF THIS FACILITY/OFFICE. I ACKNOWLEDGE THAT I HAVE THE

OPPORTUNITY TO LEAVE THE FACILITY/OFFICE IMMEDIATELY IF I CHOOSE NOT TO GIVE THIS

CONSENT TO SEARCH.

I HEREBY DECLARE THAT I HAVE READ AND UNDERSTAND, AND WILL ABIDE BY THE PROVISIONS

OF THE ABOVE REGULATIONS. I UNDERSTAND THAT VIOLATION OF ANY OF THE ABOVE

PROVISIONS, OR THE ENTERING OF ANY FALSE INFORMATION ON THIS FORM MAY RESULT IN MY

BEING BARRED FROM OR DENIED ACCESS TO THE COLORADO DEPARTMENT OF CORRECTIONS

STATE PENITENTIARY OR ANY OF ITS FACILITIES.

COMO UNA CONDICIÓN PARA ENTRAR A ESTE EDIFICIO CUAL ES LA PROPIEDAD DEl

DEPARTAMENTO CORRECCIONAL DE COLORADO, POR LA PRESENTE CONSIENTO A CUALQUIER

REVISO DE MI PERSONA Y/O CUALQUIERA DE MIS BIENES PERSONALES, O LA PERSONA DE

CUALQUIER MENOR DE EDAD QUE ME ACOMPAÑA, O DE CUALQUIER VEHÍCULO QUE TRAIGA

SOBRE LA PROPIEDAD DE ESTE EDIFICIO. RECONOZCO QUE TENGO LA OPORTUNIDAD DE SALIR

DE ESTE EDIFICIO INMEDIATAMENTE SI ELIJO NO ESTAR DE ACUERDO CON SER REVISADO.

POR LA PRESENTE DECLARO QUE HE LEÍDO Y HE COMPRENDIDO, Y CUMPLIRÉ CON LAS

PROVISIONES DE LOS REGLAMENTOS ANTES MENCIONADOS. COMPRENDO QUE INFRACCIÓN DE

CUALQUIERA DE LAS PROVISIONES ANTES MENCIONADAS, O FALSIFICACIÓN DE INFORMACIÓN

EN ESTA FORMA TENDRÁ COMO RESULTADO SER IMPEDIDO DE ENTRAR O DE ACCESO NEGADO

AL PENITENCIARIO O CUALQUIERA DE LOS EDIFICIOS DEL DEPARTAMENTO CORRECCIONAL DE

COLORADO.

SECTION I: GUEST DATA

Date: Purpose of Visit/DOC Person of Contact:

SECTION II: GUEST VEHICLE DATA

LICENSE #

STATE

MAKE OF

CAR

MODEL YEAR COLOR

IF YOU WERE A PASSENGER,

YOU MUST IDENTIFY THE

CAR IN WHICH YOU

ARRIVED

SECTION III: GUEST DATA

Name (Printed)

LAST: FIRST: MI: DOB: SEX:

ADDRESS: CITY:

ST: ZIP:

DRIVERS LICENSE # :

STATE: HEIGHT WEIGHT HAIR EYES

SOCIAL SECURITY NUMBER: (optional)

COMPANY NAME If Applicable ADDRESS:

CITY:

ST:

ZIP: PHONE: FACILITY/OFFICE/DESTINATION:

The information I have provided is correct and I have read and understand the Declaration of Consent and Waiver.

SIGNATURE

DATE

Attachment “C”