Name: / Offender No:
Docket No:
Address/Telephone:
In consideration of having been granted community supervision by the
I hereby agree to the following terms and conditions:
  1. I will obey all Municipal, County, State, Tribal, and Federal laws. I will report all law enforcement contact to any supervising agent within 24 hours.
  1. I will not own, purchase, possess, transport, carry or use weapons, ammunition, or explosives prohibited by the granting authority or forbidden by law.
  1. I will not possess or use any illegal controlled substance, nor use any mood altering substance legal or otherwise against its legal purpose. I will only use prescription medication prescribed to me by a licensed medical professional.
  1. I will submit to alcohol and drug screening as directed by any supervising agent or designee, included but not limited to; law enforcement, treatment providers, medical personnel. I will not attempt to alter, dilute, or replace a drug test.
  1. I will report for appointments with any supervising agent as directed. I shall keep any supervising agent advised of my current address, phone number, living arrangements, employment, and emergency contacts. Any changes will be reported to any supervising agent within 24 hours.
  1. I will allow any supervising agent to visit me at my residence, place of employment, or elsewhere for compliance inspectionsor other matters relating to my supervision. During such visits I understand thatI will submit my person, property, place of residence, vehicle and personal effects to search and seizure at any time, with or without a search warrant.
  1. All animals must be contained and controlled during contacts conducted by any supervising agent.
  1. I will not possess any surveillance equipment at my residence that can be used to monitor any supervising agent or law enforcement, including police scanners or video cameras.
  1. I will secure and maintain gainful and lawful employment, but will not begin or change existing employment until given prior approval by my Agent. I will pay all monetary obligations associated with supervision, will cooperate in the preparation of a payment plan, and make regular and consistent payments as directed. I will not quit or change jobs without prior approval from any supervising agentand will report loss of employment for any reason within 24 hours to any supervising agent.
  1. I will cooperate with the completion of all required assessments necessary for case planning and supervision purposes including following through with any referrals for services to address identified needs.
  1. I will take advantage of the opportunities afforded to me by supervision, will be cooperative in all respects with any WDOC staff, and will follow the directives in matters affecting my supervision. I will cooperate by promptly and truthfully answering inquires directed to me by any supervising agent.
  1. I will not enter into any agreement to act as a confidential informant, or special agent for any law enforcement agency without the written permission of the Administrator of Field Services Division.
  1. I acknowledge that intermediate sanctions may be implemented in response to violations of this agreement or conditions ordered by the granting authority.
  1. I will not have contact with the victim(s) of my offense including, but not limited to correspondence, telephone contact, text messaging, instant messaging or e-mail, or communication through a third party except under circumstances approved in advance and in writing by my Agent in consultation with the Sex Offender Therapist. I shall not enter onto the premises, travel past or loiter near where the victim resides.
  1. I will comply with all sex offender registration procedures as required by state law.
  1. I will submit to a sex offender evaluation by a Sex Offender Therapist approved by my Agent and will successfully complete any recommended treatment at my own expense. I will comply with all requirements and actively participate in treatment until released by my treatment provider. Furthermore, I will not miss individual or group therapy without the prior permission of my Agent or Sex Offender Therapist.
  1. I will not be allowed to change from the approved Sex Offender Therapist or treatment program without prior approval of my Agent.
  1. I will submit to, participate in, and pay for sex offender assessment including, but not limited to, polygraph examinations at the request of my Agent or Sex Offender Therapist.
  1. I will execute all release of information documents deemed necessary by my Agent or Sex Offender Therapist.
  1. I will reside in a residence approved by my Agent and will not move unless given authorization, nor will I allow others to reside with me unless approval has been given by my Agent and Sex Offender Therapist.
  1. I understand that a curfew, restricted community activity, a fixed schedule or visitor restrictions at my residence may be imposed by my Agent.
  1. I will remain gainfully employed and support my dependents in an occupation determined appropriate by my Agent, in conjunction with my Sex Offender Therapist, unless approved otherwise due to a disability or other circumstances.
  1. I will abide by all travel restrictions imposed by my Agent and will not leave the state or county of my residence without the approval of my Agent in conjunction with my Sex Offender Therapist. When granted permission to travel I may be required to provide a safety plan prior to departure.
  1. I understand if I am authorized to have a computer that an Agent will utilize computer software tools to determine compliance with the terms of my probation and may seize my computer at any time for forensic evaluation if deemed necessary.
  1. I will not subscribe to, use, nor have access to, internet service, e-mail or any other internet material without permission from my Sex Offender Therapist and Agent.
  1. I will not use any form of password-protected files or other methods that might limit access to, or change the appearance of, data images or other computer files.
  1. I will not have a cell phone with camera and/or internet technology and understand that my Agent may view information on my cell phone at any time.
  1. I will not be in the presence of a minor child without approval from my supervising Agent and Sex Offender Therapist.
  1. I will have no unsupervised contact with a minor child without the permission of Agent and/or Sex Offender therapist.
  1. I will not form relationships with anyone who has physical or shared custody of any minor child, nor will I reside or visit a residence where minor children reside or are present, except as approved by my Agent and Sex Offender Therapist.
  1. I will not frequent or loiter near locations including; parks, playgrounds, daycare centers, schools, video arcades, swimming pools, or any other areas identified by my Agent or Sex Offender Therapist unless given approval.
  1. I will not call sexually oriented businesses and shall provide telephone records to my Agent upon request.
  1. I will not associate with other sex offenders with the exception of therapeutic sessions unless permission has been granted by my Agent and/or Sex Offender Therapist.
  1. I will not possess, rent, or access pornography in any form. This includes, but is not limited to books, magazines, art work, films, games or electronic/internet media.
  1. I acknowledge that WDOC staff has provided me with 24 hour contact information for my use should an emergency arise and I need to have contact with WDOC staff. I further understand that an emergency is defined as: “A significant disruption of normal life function such as a medical or other family emergency that needs an immediate response from the agent and cannot wait until the next business day.”
  1. I have been advised of the Wyoming Department of Corrections Grievance Procedure. I am aware that I can request a copy of the Operational Standard and Procedure at any time or access it in the lobby of the Probation/Parole Office.
  1. I understand the necessary process for reporting sexual misconduct by staff or other offenders. I also understand the penalties for false reporting, the requirement for confidentiality, and the process for investigation and reporting by WDOC in the case of a sexual misconduct report. I also received a copy of the Department of Corrections PREA pamphlet.
  1. The use or possession of tobacco, tobacco related products, smokeless tobacco, or tobacco substitutes is prohibited on all WDOC property. (You may not have it on your person when entering the field office for any reason.)

I have read or have had read to me, fully understand, and agree to abide by the above conditions of supervision. I understand that any supervisingagent has the authority to place me in custody at any time and may begin revocation proceedings if I am alleged to be in violation of any of the conditions of this agreement. I do also hereby voluntarily waive extradition to the State of Wyoming from any state or U.S. Territory if I am charged with a violation.

Dated: / Signed:
Agent/Caseworker:

04/04/16