Waiver of Liability for Replacement of Personal Eyeglasses

IDAHO DEPARTMENT OF CORRECTION
Waiver of Liability for Replacement of Personal Eyeglasses
I, , am requesting permission to keep my personal
eyeglasses during my incarceration with the Idaho Department of Correction (IDOC). I release
the IDOC, IDOC staff, and IDOC contract medical providers from liability for the loss, damage,
and/or theft of my personal eyeglasses.
I understand that should my personal eyeglasses be lost, damaged, or stolen during my
incarceration neither the IDOC, IDOC staff, nor IDOC contract medical providers will reimburse
me for the cost of my personal eyeglasses; however, the IDOC or IDOC contract medical
provider will replace my eyeglasses with a standard state-issue pair of eyeglasses.
I also understand that I may, at any time, decide to send my eyeglasses out at my expense and
have them replaced with a state-issue pair of eyeglasses.
Inmate's signature IDOC# Date
320.02.01.001
(Form last updated on 02/16/2017)