Video Call Informed Consent

As a participant in the TeleStory program at Brooklyn Public Library, you must agree to allow Brooklyn Public Library to share some basic information about you with the New York state Department of Corrections and Community Supervision (“DOCCS”).

  • The Library will share the following information about you: first and last name and your relationship to the incarcerated person that you are calling.
  • DOCCS will use your information to process applications. DOCCS may
    ask you to provide documentation to confirm your relationship with the incarcerated
    individual.
  • DOCCS will keep your information for up to six years.
  • DOCCS will keep your information in a secure record retention storage area.
  • DOCCS may share your information with other federal, state or city agencies pursuant to a subpoena or other legal obligation.

 

Certifications

To be completed by all TeleStory participants 18 years and older:

I certify that I am over 18 years of age, I have read this Video Call Informed Consent Form, and I hereby consent to allow Brooklyn Public Library to share my first and last names along with my relationship to the incarcerated person that I am visiting with the New York state Department of Corrections and Community Supervision.

Sign above

I certify that I am the parent or legal guardian of a minor, I have read this Televisit Informed Consent Form, and I hereby consent on the minor’s behalf to allow Brooklyn Public Library to share the minor’s first and last names along with their relationship to the incarcerated person that they are visiting with the New York City Department of Correction. I further certify that I know of no court order (such as an order of protection) that would prevent the minor from visiting the incarcerated person through the televisit program at Brooklyn Public Library. Please list additional children if applicable.

Minor(s)
Sign above
Sign above