Enrollment Form

Welcome

Please complete this form to enroll in the VCheck24 program. Submission of this form constitutes your acknowledgment and acceptance of the program rules and billing authorization described below. After submission, you will receive a secure payment link to complete enrollment.

Personal Information

First name

Last name

Phone Number

Address

Program Rules – Must Be Accepted

As a condition of my participation in the Program, I agree to properly use the VCHECK24 monitoring app provided to me by my monitoring authority, and to keep the app active on my smartphone at all times while on the program. This includes allowing the VCHECK24 app access to my camera, Bluetooth, location services (all the time), microphone, and cellular data for the duration of my time on the monitoring program.

I understand that I may receive SMS text messages from the VCheck24 system and agree to this. In addition, I agree to keep push notifications for the app turned ON at all times. In that regard, I will perform ALL scheduled, unscheduled/random, and system-generated check-ins and keep my cell phone adequately charged at all times. I further agree not to turn off or deactivate location services on my cell phone.

I shall perform my check-ins at times and locations as instructed, if specified by my monitoring authority. I further understand that when a VCHECK24 check-in is prompted, my phone may vibrate and sound a tone which is my prompt to perform a check-in and that for each check-in, I have 15 minutes to complete the check-in before it is considered late or missed.

I further agree to the foundation and admissibility of reports from the VCHECK24 program as a business record.

I have read, understand, and agree to the Program Rules above and acknowledge that compliance is required for continued participation in the program.

Billing & Payment Authorization

I understand that participation in the program may require recurring monthly billing. I authorize VCheck24 to charge my payment method on a recurring basis for program services until my participation ends or I cancel in accordance with program policies.

I understand that I will receive a secure payment link via email and/or text message to complete my initial payment and to enroll in automatic monthly billing.

Note: If you are on VCheck24 as a condition of BOND or PRETRIAL release and/or you will be paying a month-to-month program fee, your first month payment is due up front.

Additionally, you agree to provide your credit/debit card details to enroll in regular monthly program payments. Your next automatic payment will run approximately 30 days after making your initial monthly program payment.

I authorize recurring billing for program services as described above and understand that my payment method will be charged automatically each billing cycle.

By signing below, I certify that the information provided is accurate and that I agree to all program rules and billing terms described above. I acknowledge that this authorization is effective as of the date of submission.

Signature

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