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Offender’s name: IDOC#: <br /> 1. Offenders are prohibited from any place identified in the Idaho Department of Correction (IDOC) Sex Offender Agreement of Supervision without an approved chaperone. <br /> 2. Chaperones must be willing and able to hold the offender accountable to treatment guidelines and conditions of probation or parole. <br /> 3. Chaperones must be willing and able to report any problems or concerns to the offender’s supervising probation and parole officer (PPO). <br /> 4. Approval of chaperone supervision is for specific, individual activities only as approved in writing by the supervising PPO. Sex offenders are not allowed to go to prohibited areas <br />or activities with a chaperone unless it is approved in writing by the supervising PPO. <br /> 5. Chaperone privileges can and will be revoked for, but not limited to, the following issues: <br />If the chaperone is unable or unwilling to hold the offender accountable to the treatment guidelines and the conditions of probation or parole; <br />If the chaperone is unable or unwilling to report any problems or concerns to the offender’s supervising PPO; and <br />If the chaperone does not adhere to activity specified and approved as noted on the Sex Offender Supervision Activity Request and Sex Offender Supervision Activity Request Safety Plan; <br />and/or if the chaperone escorts the offender into prohibited situations. <br /> Proposed Chaperone’s Statement of Agreement <br />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, <br />if I do not adhere to these IDOC guidelines, my chaperone status may be immediately revoked. <br /> _____________________________________________ <br />Proposed Chaperone’s Printed Name <br /> <br />Proposed Chaperone’s Signature Date <br /> Witnesses (as applicable) <br /> _____________________________________________ <br />PPO’s Printed Name <br /> <br />PPO’s Signature Date <br /> _____________________________________________ <br />Treatment Provider’s Printed Name <br /> <br />Treatment Provider’s Signature Date