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BAT (Bicycle Anti-Theft) Consent Form

Last Name: First Name:

Middle Name:

Street Address:

City: State: Zip:

Home Phone: Local Phone:

Student I.D. #: D.O.B.:

I am the registered owned of the following bicycle:

Make of Bicycle: Model:

Color: Serial #:

Owner Applied #:

Description:

I confirm that I have fully read and understand the regulations and procedures explained on the right side of this page.

Security Image

I have volunteered to participate in the Valdosta State University B.A.T. Program, a bicycle decal registration program with the VSU PD. I will receive a numbered decal which will be placed on the cross bar part of the frame between the seat and handle bars. Acceptance of this consent form, by VSU PD enrolls the above described bicycle into the B.A.T. Program.

I consent to and authorize any VSU PD officer to stop the above enrolled, described bicycle when it is being ridden between the hours of 11:00pm and 6:00am.

I understand that upon terminating participation in the B.A.T. Program or upon selling or otherwise transferring ownership of my bicycle which is enrolled in the B.A.T. Program, I must remove the decal and notify VSU PD.

I hereby consent and agree to abide by these procedures. I confirm that I have fully read and understand the above and all information has been completed prior to signing. Call the Crime Prevention Office at 219-3199 for an appointment to sign this form and pick up your decal.

Signature: _________________________ Date: ___________________________________

Witness - Notary Public or Law Enforcement Employee: _________________________

Decal Number: ________________________

If you do not want to send the form electronically, you can print the completed form and mail to:

Sgt. Matt Maestas
Crime Prevention
Valdosta State University Police Department
1500 N. Patterson Street
Valdosta, GA 31698
Telephone: (229) 219-3199
Fax: (229) 249-4863
E-mail: mrmaesta@valdosta.edu