WCC Visitation and Orientation Form (English)

Fill out the interactive form below, or print the PDF version of the form, fill it out and bring it to the Western Massachusetts Regional Women’s Correctional Center. The video below contains the rules and orientation information needed for visitation.

[su_youtube url=”https://youtu.be/3NhZpt6NsXc”]

PLEASE DO NOT YET USE THE FORM BELOW FOR REGISTRATION. EITHER PRINT THE PDF ABOVE OR REGISTER IN PERSON AT WCC. THANK YOU!

Inmate Name *

Inmate Date of Birth *

Have you ever been incarcerated? *

• Yes
• No

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

Have you ever been convicted of a felony? *

• Yes
• No

Do you have any open court cases? *

• Yes
• No

Are you currently on Probation? *

• Yes
• No

Is there an active Restraining Order between you and the above inmate? *

• Yes
• No

Have you visited any other inmates here in the past? *

• Yes
• No

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? *

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

My true name is: *

First

Last

My date of birth is: *

My present address is: *

My phone number, including area code, is: *

Driver’s License Number: *

My email address is:

I understand the visiting rules and regulations of the Women’s Correctional Center as relayed in the video. I agree to abide by them during my visit at WCC. *

• I agree

As part of the visitation request process, I acknowledge that permission to visit may require that the Hampden County Sheriff’s Department 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. *

• I grant permission

Any additional comments or notes for HCSD staff:

Submit