XRNYC Jail Support Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Some "Know Your Rights" resources can be found at http://xrr.nyc/KYR
Magic Phrases and the Three Levels of engagements with Police.

First Name *

Last Name *

Nicknames

Phone number *

Birthdate *

YYYY

I am a minor *

Yes

Gender

Do you have the Signal app on your phone? Can you download it if not?

Yes

Other:

Clear selection

Any medical conditions, allergies, or medications you want us to know about?

Emergency contact

Person's relationship to you

Their phone number

Can we release your name and/or photo to the press?

Name

Photo

Both

Neither

Clear selection

Anything else?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report