APPENDIX D

SAMPLE PAROLE CONDITIONS FOR SEX OFFENDERS

By order of the _________________________ Court or the Parole Board you have been placed on supervision with the Division of Field Services. In addition to its standard terms and conditions of probation/parole the fallowing checked conditions shall apply:

___	□	1.	I agree to meaningfully participate in a New Hampshire Department of Corrections approved sex offender treatment program and abide by the sex offender treatment contract.
___	□	2.	I agree to submit to polygraph testing, at my expense, at the direction of the Probation/Parole Officer.
___	□	3.	I agree not to have any contact with minors (male/female) unless approved by the therapist and Probation/Parole Officer. Any approved contact with minors shall be supervised at all times by a trained Department of Corrections approved chaperone. I will remain in eyesight of the chaperone at all times. I will not discipline minors. I will not be around children when either party is in a state of undress. I will never be in a minor's bedroom. I will not discuss sexuality-related issues or dating with minors except within a treatment environment. I will not initiate, maintain or permit any physical contact with minors, and will not sit directly next to minors without the permission of the Probation/Parole Officer and therapist.
___	□	4.	I will not frequent places where minors congregate including, but not limited to, parks, playgrounds, campgrounds, shopping malls, swimming pools, etc.
___	□	5.	I agree to not purchase, possess, or use any sexually stimulating materials as defined by sex offender treatment staff.
___	□	6.	I agree to not have any romantic involvement or living arrangement with any individual without the individual being informed of sexual deviancy and criminal offenses, and only with the permission of the treatment staff and Probation/Parole Officer.
___	□	7.	I agree to not possess any Polaroid-type cameras, VCR or camcorder.
___	□	8.	I agree to not have access to or use on-line computer services and computer programs that access or contain sexually arousing contents.
___	□	9.	I agree to keep a daily activity log.
___	□	10.	I agree to not pick up hitchhikers while driving or as a passenger, and I agree not to hitchhike
___	□	11.	I agree to maintain a detailed daily destination and mileage log.

I understand that failure to abide by these conditions or the standard rules of probation/parole may result in my arrest and incarceration.

Date	Signature of Probationer/Parolee
Date	Signature of Probation/Parole Officer

PAROLE CONDITIONS AND RESTRICTIONS

I agree to the following and understand that failure to comply with these conditions will subject me to arrest:

1.	I will report to the parole officer at such times and places as directed. I will comply with the parole officer's instructions and respond truthfully to all inquiries from the parole officer.
2.	I will comply with al1 lawful orders of the court and the parole board, and all instructions of the parole officer, including all court orders for the payment of fines, restitution, attorney's fees, and child support, and the parole supervision fee mandated by RSA 504-A:13.
3.	I will obtain the parole officer's permission before changing residence or employment or traveling out of state.
4.	I will notify the parole officer immediately of any arrest, summons or questioning by a law enforcement officer.
5.	I will diligently seek and maintain lawful employment, notify my employer of my parolee status, and support my dependents to the best of my ability.
6.	I will not receive, possess, control or transport any real or simulated weapon, explosive, or firearm.
7.	I will be of good conduct and obey all laws.
8.	I will submit to breath, blood or urinalysis testing for the presence of any substance, or provide such other sample for testing, or submit to such other test or procedure, as may be directed by the parole board or my parole officer.
9.	I will permit the parole officer to visit my residence at any time for the purpose or examination and inspection in the enforcement of the conditions of parole, and submit to searches of my person, property, and possessions as requested by the parole officer.
10.	I will not associate with criminal companions or such other individuals as shall be ordered by the court or parole board. Prohibited contacts include victims, other parolees or probationers, and other persons known to the board or to the parole officer as having criminal records.
11.	I will not illegally use, sell, possess, distribute, or be in the presence of controlled drugs, shall notify the parole officer of any prescribed medications, and shall not use alcoholic beverages to excess.
12.	I waive extradition to The State of New Hampshire from any state in the United States or any other place, agree to return to New Hampshire if directed by the parole officer, and will be responsible for any and all costs including all travel, in connection with any extradition request or proceeding.
13.	The following specific conditions are imposed by the court or parole board:

A.	□	I will participate regularly in Alcoholics Anonymous/Narcotics Anonymous to the satisfaction of the parole officer.
B.	□	I will secure written permission from the parole officer prior to purchasing and/or operating a motor vehicle.
C.	□	I will participate in and satisfactorily complete the following program:
D.	□	I will enroll and participate in mental health counseling on a regular basis to the satisfaction of the parole officer.
E.	□	I will not be in the unsupervised company of (female/male) minors at any time.
F.	□	I will not leave the county without permission of the parole officer.
G.	□	I will refrain totally from the use of alcoholic beverages.
H.	□	I will execute, and deliver all necessary documents to release any and all otherwise privileged reports relating to medical or mental health care, counseling, employment, or income as may be requested by the parole officer.
I.	□	Other.

If you violate any of the conditions of your parole, you are subject to arrest, revocation of your parole, and return to the NH State Prison.

I hereby certify that I have this date received a copy of the rules and regulations of parole. I have read or had read to me the conditions, and I fully understand and agree to comply with them.

Signature of Witness	Signature of Parolee
Title	Dated