WCC Visitation and Orientation Form

WCC Visitation Request Form

Fill out the interactive form below to request a visit with an inmate at the Western Massachusetts Regional Women’s Correctional Center.

Inmate Name(Required)

Inmate Date of Birth(Required)

MM slash DD slash YYYY

Have you ever been incarcerated?(Required)

YES

Do you wish to visit in person or by video?(Required)

In-Person Visit

Video Visit

Both

If previously incarcerated, in which state did you serve time?

Have you ever been convicted of a felony?(Required)

YES

Do you have any open court cases?(Required)

YES

Are you currently on Probation?(Required)

YES

Is there an active Restraining Order between you and the above inmate?(Required)

YES

Have you visited any other inmates here in the past?(Required)

YES

If yes, name the inmate and list when the visit took place:

What is your relationship to the above inmate you are requesting to visit? *(Required)

For example: Wife, Mother, Sister, Daughter, Friend, etc.

My true name is:(Required)

First Last

My date of birth is:(Required)

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

My phone number, including area code, is:(Required)

Driver’s License Number:(Required)

As part of the visitation request process, I acknowledge that permission to visit may require that the Hampden County Sheriff’s Office run a criminal records check on me. I hereby give my permission to the Hampden County Sheriff’s Department to run a query on me through CJIS for the sole purpose of determining my eligibility to visit.(Required)

I grant permission

I understand the visiting rules and regulations of the Women’s Correctional Center. I agree to abide by them during my visit.(Required)

I agree

Any additional comments or notes for HCSO staff:

This form was made and signed under penalty of perjury on:(Required)

MM slash DD slash YYYY

Signature confirming all information provided is true(Required)