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Diversion Agreement JU 06.0120 - Washington
| Diversion Agreement Form. This is a Washington form and can be used in Diversion Juvenile Court Statewide . |
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Juv # Referral # County Juvenile Court Diversion Agreement (DAS) Name: Mailing Address: Physical Address: Offense(s): Offense Date: DOB: Telephone: ( ) I agree to enter into this Diversion Agreement and complete the conditions and requirements rather than have my case heard in court before a judge. By signing this agreement, the offenses listed above will become a part of my juvenile criminal history. This agreement will include the following conditions: *Restitution: I will pay $ At the rate of $ My first payment is due by Joint and Several with: for damages/loss/injury incurred by the victim(s). per month, by the of each month. and will be paid in full by Referral # . . Community Restitution: I will perform _________ hours of volunteer work, at a placement approved by the diversion officer. These hours will be completed by . Educational/Information/Restorative Justice Program: I will attend and complete: , by , by The Diversion Unit is not responsible for any cost of counseling, educational, restorative justice, and/or informational sessions. All costs incurred are payable by the parent. Counseling: I will attend sessions/hours with to be completed by . The Diversion Unit is not responsible for any cost of counseling, educational, restorative justice, and/or informational sessions. All costs incurred are payable by the parent. , to be . I also agree to follow any recommendation(s) Evaluation: I will have an evaluation through completed by resulting from the evaluation. *Fine: I will pay $ . To be paid by . * Fines and restitution are to be paid through: Physical Address: Mailing Address: DIVERSION AGREEMENT (DAS) - Page 1 of 2 WPF JU 06.0120 (06/2012) - RVW 13.40.080 American LegalNet, Inc. www.FormsWorkFlow.com Juv # Referral # Mandatory Notification(s): DOL: The Department of Licensing will be notified of this offense. School Notification: Your school Principal will be notified of this offense: School: The following conditions are for the duration of the Diversion Agreement: Curfew: Week days School Attendance at: Restricted from the following locations: Refrain from any contact with the following victims or witnesses: Special instructions: Weekends during required school hours. Review date: No Review date scheduled at this time. If I fail to complete the above conditions, my Diversion Agreement may be terminated and my case sent back to the prosecuting attorney for court action. Date: Juvenile: Diversion Parent Fee: $ Fee paid Fee will be paid by: Other Parent/Guardian: Date: CAB Member: CAB Member: CAB Member: Parent/Guardian: Counselor: CAB Member: CAB Member: CAB Member: DIVERSION AGREEMENT (DAS) - Page 2 of 2 WPF JU 06.0120 (06/2012) - RVW 13.40.080 American LegalNet, Inc. www.FormsWorkFlow.com
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