SO Supervision Chaperone Agreement

Client’s name: IDOC#:
1. Clients are prohibited from any place identified in the Idaho Department of Correction (IDOC) Sex Offender Agreement of Supervision without an approved chaperone.
2. Chaperones must be willing and able to hold the client accountable to treatment guidelines andconditions of probation or parole.
3. Chaperones must be willing and able to report any problems or concerns to the client’s supervising probation and parole officer (PPO).
4. Approval of chaperone supervision is for specific, individual activities only as approved in writing by the supervising PPO. Clients are not allowed to go to prohibited areas or activities
with a chaperone unless it is approved in writing by the supervising PPO.
5. Chaperone privileges can and will be revoked for, but not limited to, the following issues:If the chaperone is unable or unwilling to hold the client accountable to the treatment
guidelines and the conditions of probation or parole;If the chaperone is unable or unwilling to report any problems or concerns to the client’s supervising PPO; andIf the chaperone does
not adhere to activityspecified and approved as noted on the Sex Offender Supervision Activity Request/Safety Plan; and/or if the chaperone escorts the client into prohibited situations.
Proposed Chaperone’s Statement of Agreement
I have read or have had this agreement read to me, and I agree to these IDOC guidelines as written and as verbally explained to me. I am aware that upon being approved to be a chaperone,
if I do not adhere to these IDOC guidelines, my chaperone status may be immediately revoked.
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Proposed Chaperone’s Printed Name
Proposed Chaperone’s SignatureDate
Witnesses (as applicable)
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PPO’s Printed Name
PPO’s SignatureDate
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Treatment Provider’s Printed Name
Treatment Provider’s SignatureDate