"Emergency Contact Information Form (Offender)" - Idaho

Emergency Contact Information Form (Offender) is a legal document that was released by the Idaho Department of Correction - a government authority operating within Idaho.

Form Details:

Released on December 2, 2014;
The latest edition currently provided by the Idaho Department of Correction;
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IDAHO DEPARTMENT OF CORRECTION

Emergency Contact Information Form (Offender)

In the case of a medical emergency or death, the Idaho Department of Correction (IDOC) will make

notifications based on the information you provide on this form. IDOC will begin with the primary and then

secondary contacts. Once IDOC has made contact with one of your emergency contacts, no further contacts

will be made. It is up to the person contacted to contact the remainder of your family or friends. If no one

listed on this form can be contacted, IDOC will attempt to locate your next of kin or an approved visitor.

Periodically, IDOC will ask you to complete a new Emergency Contact Information Form to ensure your

primary and secondary contact information remains up-to-date. However, it is your ultimate responsibility to

update the information you provide on this form should there be changes.

Primary Contact:

Name:

Relationship:

Address (physical):

Address (mail):

Home phone:

Cell phone:

Work phone:

Secondary Contact #1:

Name:

Relationship:

Address (physical):

Address (mail):

Home phone:

Cell phone:

Work phone:

Secondary Contact #2:

Name:

Relationship:

Address (physical):

Address (mail):

Home phone:

Cell phone:

Work phone:

Property Disposal Information:

In the event of my death, I name the following individual or charitable organization (limited to one

designation) to receive my property and any remaining money I have left in my Offender Trust Account after

all expenses have been settled. Any remaining money will be mailed to the designated individual or

charitable organization in accordance with SOP 114.03.03.011, Offender Trust Account.

Name:

Relationship:

Address (physical):

Address (mail):

Home phone:

Cell phone:

Work phone:

Offender Name:

IDOC Number:

(print)

Offender signature:

Date:

Witness

Name:

Associate (employee) #:

(print)

Witness signature:

Date:

Property (Non-money) Pick Up Signature:

Date:

Distribution: Original to central file; Copy to offender

(updated 12/2/2014)