Jail Release Form

Jail Release Form and Release Agreement

RECITALS

WHEREAS, Correctional Facility Name: (the Facility) is legally responsible for custody of persons admitted to its care; and

WHEREAS, The person identified below is held in custody and is eligible for release under the conditions described herein; and

WHEREAS, the Facility and the recipient of the released person desire to document the terms, conditions, and certifications relating to the release and any property transferred at the time of release.

INMATE INFORMATION

Date of Birth: | Housing Unit/Cell:

RELEASE AUTHORIZATION

Release Date: Time of Release:

Bail / Bond   Court Order   Sentence Completed   Transfer to Other Facility   Other (specify):

AUTHORIZED RECIPIENT / TRANSPORT

Recipient Relationship to Inmate:

SCOPE OF RELEASE / SERVICES

The Facility agrees to release custody of the inmate named above to the authorized recipient identified in this form, to return the inmate's personal property as inventoried below, and to provide necessary documentation of release. The recipient agrees to accept custody and responsibility for the released person and to comply with all applicable post-release conditions imposed by court order or statute.

PROPERTY INVENTORY

Has personal property been returned to the recipient?   Yes   No

PAYMENT TERMS

The recipient and/or inmate shall be responsible for any fees required by the Facility in connection with release. Those fees must be paid in full prior to release unless otherwise authorized in writing by the Facility.

TERM AND TERMINATION

This Release Agreement is effective as of: and shall remain in effect until all obligations described herein are fulfilled or until: .

CONFIDENTIALITY

Medical, booking, and protected personal information regarding the inmate may be disclosed only to the extent required by statute, court order, or to effectuate this release. The recipient agrees to maintain the confidentiality of any non-public information obtained in connection with the release and to refrain from further disclosure except as required by law.

INDEMNIFICATION AND RELEASE

The recipient and/or the inmate hereby release, indemnify, and hold harmless the Facility, its employees, agents, and contractors from any claims, liabilities, losses, costs, or damages arising out of the release, transfer, transportation, or subsequent conduct of the released person, except to the extent caused by the Facility's gross negligence or willful misconduct.

GOVERNING LAW; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the state or jurisdiction in which the Facility is located. This document constitutes the entire agreement between the parties concerning the release and supersedes all prior written or oral agreements on the subject.

OFFICER CERTIFICATION

Officer Badge/ID Number:

ACKNOWLEDGMENTS

By signing below, the parties certify that they have the authority to enter into this Agreement, that the information provided is true and accurate to the best of their knowledge, and that they understand the legal consequences of accepting custody and responsibility for the released person.

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