Private GPS Application

1 Welcome and Important Instructions

This Intake Form is the first step in the SafeTracks Private Rental GPS Electronic Monitoring Program. The information collected is used by SafeTracks to review the file, create a Participant profile, assess the proposed monitoring location, assess cellular coverage considerations, identify relevant court and release information, and determine whether the file can proceed to the next stage.

Submitting this Intake Form does not guarantee acceptance into the SafeTracks Program, installation of a GPS monitoring device, or release from custody. SafeTracks must review the information provided and may request additional information before proceeding.

Incomplete or inaccurate information may delay review, approval, installation, or activation.

Person Completing This Form

Full Name

Relationship to Participant

Phone Number

2 Participant Information

First Name

Middle Name

Last Name

Known Alias / Nickname / Street Name

Date of Birth

Is the Participant classified as a Youth for this matter?

Legal Guardian Information

For youth files, the legal guardian is treated as the proposed Primary Payer unless another approved adult or organization is identified in writing. Final Primary Payer responsibility is subject to SafeTracks approval and completion of the required agreement.

Legal Guardian Full Name(s)

Best Phone Number for Legal Guardian(s)

Legal Guardian Email Address

Relationship to Participant

Gender

Please Specify Gender

Ethnicity

Please Specify Ethnicity

Primary Language

Please Specify Language

Primary Phone

Secondary Phone

Physical Identifying Information

Height Unit

Feet

Inches

Centimetres

Weight Unit

Pounds

Kilograms

Hair Colour

Please specify hair colour

Eye Colour

Please specify eye colour

Identifying Marks / Tattoos

3 Residence / House Arrest / Curfew Address and Coverage Review

Address Line 1

Address Line 2 / Unit / Apartment

City

Province

Postal Code

Residence Type

Does the residence have a tin or metallic roof?

Is Wi-Fi available at the residence?

Is the residence rural or remote?

Additional notes about possible alternative address

4 Court / Release Plan Information

Prior Electronic Monitoring

Has the Participant ever been on electronic monitoring before?

With which organization or program?

Why was the Participant previously monitored?

Why was the Participant removed from monitoring?

Court/ Release Details

Bail / Court Date

Expected Date of Release

Court File Number

Release Type^*

Charges^*

5 Lawyer and Authority Contacts

Defence Counsel / Lawyer Information

Lawyer Name

Law Office

Office Phone Number

Cell Phone Number

Is the Participant represented by Legal Aid?

Probation / Supervising Officer

Will the Participant be subject to a probation / supervising officer?

Probation /Supervising Officer Name

Probation /Supervising Officer Phone Number

Probation /Supervising Officer Email

Arresting Police Officer

Do you have the Arresting Police Officer's information?

Arresting Police Officer Name

Arresting Police Officer Phone Number

Arresting Police Officer Email

Crown Prosecutor

Do you have the Crown Prosecutor's information?

Crown Prosecutor Name

Crown Prosecutor Phone Number

Crown Prosecutor Email

Assigned Judge

Do you have the Assigned Judge's information?

Assigned Judge Name

Assigned Judge Phone Number

Assigned Judge Email

Justice of the Peace

Do you have the Justice of the Peace's information?

Justice of the Peace Name

Justice of the Peace Phone Number

Justice of the Peace Email

6 Co-Signer Information Required

SafeTracks requires a Co-Signer in every private rental file.

The Co-Signer is the person who must enter into the separate SafeTracks Co-Sign Agreement and assume financial responsibility for amounts owing to SafeTracks in accordance with that agreement.

A Co-Signer is not appointed by SafeTracks as a court surety and does not replace any surety appointed or approved by the Court.

The SafeTracks Co-Sign Agreement is mandatory and must be completed before the Participant can proceed to installation, activation, or release with the GPS monitoring device.

SafeTracks will contact the Co-Signer directly to complete the Co-Sign Agreement.

Co-Signer First Name

Co-Signer Last Name

Relationship to Participant

Phone

Address Line 1

Address Line 2

City

Province

Postal Code

7 Installation Location

Installation Location Type

Please specify installation location type

Name of Remand Centre / Police Detachment / Facility

Address Line 1

Address Line 2

City

Province

Postal Code

Expected Installation Date

8 Fee Schedule and Payment Information

Mandatory / Required Fees

Fee Item	Amount
Engagement Fee Charged for Administration Costs	$250.00
Required Deposit	$500.00
Installation Fee	$250.00 + mileage
Monthly Monitoring Service Fee	$500.00/month
Monthly Monitoring Service Fee — Legal Aid and Youth	$400.00/month
Ankle Bracelet Removal Fee — End of Program	$250.00 + mileage
Beacon (if required)	$45.00/month

Optional Services

Fee Item	Amount
Court Call — WebEx / Virtual	$250.00 for the first 60 minutes; $100.00/hour thereafter
Standard Notarized Affidavit	$150.00
Customized Wet Ink Notarized Affidavit	$250.00

9 Payment Instructions and Statement of Account

SafeTracks does not collect credit card information through this Intake Form.

After this Intake Form is submitted, the SafeTracks judicial team will review the information provided. If all required information has been entered correctly, the person who submitted the Intake Form will receive an email from our accounting team. This email will include the invoice for the Engagement Fee and any selected add-on items, payment instructions, and a secure payment link through SafeTracks’ approved payment processor.

At the time this Intake Form is submitted, the only mandatory amount due is the $250.00 Engagement Fee charged for administration costs.

The Engagement Fee must be paid through SafeTracks’ approved payment process before the file can proceed to the next stage. If the Engagement Fee is not paid, SafeTracks will not issue the SafeTracks GPS Letter of Acceptance, and the file may be delayed or unable to proceed to approval, documentation, installation, activation, or release with the GPS monitoring device.

Additional fees, including the deposit, installation fee, monthly monitoring fee, beacon fees where required, and optional service fees, will become payable later in accordance with SafeTracks’ fee schedule, Program requirements, and applicable agreements.

10 Acceptance Procedure and Installation Guidelines

Before SafeTracks can install a GPS monitoring device, all required intake, review, payment, court, and release steps must be completed.

Intake Form is submitted to SafeTracks.
SafeTracks reviews the file and determines whether the file can proceed.
SafeTracks reviews residence information and cellular coverage considerations.
The Engagement Fee is paid through SafeTracks’ approved payment process.
SafeTracks provides acceptance documentation and program information for counsel/court where applicable.
SafeTracks must receive a copy of the signed court order or release document from the release centre.
SafeTracks coordinates with the remand centre, correctional facility, counsel, or approved parties.
SafeTracks schedules installation when the Participant is ready and the required conditions have been met.
After installation and release, the Participant must travel directly to the approved residence unless the order allows otherwise.

Timing Note: From the time SafeTracks receives the signed court order and all required materials, installation and release coordination may take up to 48 hours, Monday to Friday, subject to operational availability, facility coordination, and completeness of documentation.

Optional Supporting Documents

Drag & Drop Files Here

Browse Files

11 Optional Deliverables / Add-On Services

Optional Deliverable	Amount
Court Call — WebEx / Virtual	$250.00 for the first 60 minutes; $100.00/hour thereafter
Standard Notarized Affidavit	$150.00
Customized Wet Ink Notarized Affidavit	$250.00

Optional Deliverable

Court Call — WebEx / Virtual Standard Notarized Affidavit Customized Wet Ink Notarized Affidavit

Optional Deliverable Notes / Details

12 Final Acknowledgements and Electronic Signature

I certify that the information provided in this Intake Form is true and accurate to the best of my knowledge.^*

I understand that this Intake Form is the first step in the SafeTracks private rental process and that submitting this form does not guarantee acceptance into the Program, installation, activation, or release.^*

I understand that incomplete or inaccurate information may delay or prevent SafeTracks’ review, approval, installation, activation, or the Participant’s participation in the Program.^*

I understand that SafeTracks may rely on the information provided to review the file, create a Participant profile, assess monitoring feasibility, review cellular coverage considerations, coordinate with approved parties, and determine whether the file can proceed.^*

I understand that SafeTracks may contact the Participant, Co-Signer, Defence Counsel, or other approved parties to verify information or request additional materials.^*

I understand that the SafeTracks Co-Sign Agreement is mandatory in every private rental file and must be completed before installation, activation, or release with the GPS monitoring device.^*

I understand that release timing depends on the court, remand/correctional facility, SafeTracks scheduling, payment, and required documentation.^*

I agree that my typed or drawn electronic signature confirms that I am the person submitting this Intake Form and that the information provided is true and accurate to the best of my knowledge.^*

Full Legal Name of Person Signing

How would you like to sign this Intake Form

Email of Person Signing

Date Signed

Typed Signature

Signature

Alberta, Canada

info@safetracksgps.ca

1 Welcome and Important Instructions

Person Completing This Form

2 Participant Information

Legal Guardian Information

Physical Identifying Information

3 Residence / House Arrest / Curfew Address and Coverage Review

4 Court / Release Plan Information

Prior Electronic Monitoring

Court/ Release Details

Release Type^*

Charges^*

5 Lawyer and Authority Contacts

Defence Counsel / Lawyer Information

Probation / Supervising Officer

Arresting Police Officer

Crown Prosecutor

Assigned Judge

Justice of the Peace

6 Co-Signer Information Required

7 Installation Location

8 Fee Schedule and Payment Information

Mandatory / Required Fees

Optional Services

9 Payment Instructions and Statement of Account

10 Acceptance Procedure and Installation Guidelines

Optional Supporting Documents

11 Optional Deliverables / Add-On Services

12 Final Acknowledgements and Electronic Signature

Quick Links

Private GPS Rental

PrimeMobile-R4

Alberta, Canada

info@safetracksgps.ca

1 Welcome and Important Instructions

Person Completing This Form

2 Participant Information

Legal Guardian Information

Physical Identifying Information

3 Residence / House Arrest / Curfew Address and Coverage Review

4 Court / Release Plan Information

Prior Electronic Monitoring

Court/ Release Details

Release Type*

Charges*

5 Lawyer and Authority Contacts

Defence Counsel / Lawyer Information

Probation / Supervising Officer

Arresting Police Officer

Crown Prosecutor

Assigned Judge

Justice of the Peace

6 Co-Signer Information Required

7 Installation Location

8 Fee Schedule and Payment Information

Mandatory / Required Fees

Optional Services

9 Payment Instructions and Statement of Account

10 Acceptance Procedure and Installation Guidelines

Optional Supporting Documents

11 Optional Deliverables / Add-On Services

12 Final Acknowledgements and Electronic Signature

Quick Links

Private GPS Rental

PrimeMobile-R4

Release Type^*

Charges^*