IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of ) ) ) ) ) Case No. a child WAIVER OF COUNSEL I, the undersigned child, years of age, understand: 1. That a complaint of delinquency, alleging that I did: has been made against me; 2. That I have a right to a lawyer and that if I am unable to pay a lawyer and wish to have one appointed, a lawyer will be provided immediately. I understand this right to and offer of a lawyer and, being aware of the effect of this waiver, I knowingly, intelligently, understandingly and of my own free will now choose to and, by the signing of this waiver, do hereby waive my right to a lawyer and elect to proceed in this case without benefit of a lawyer. Dated: , 20 . _______________________________________ Child This waiver of counsel was signed in the presence of the undersigned witnesses who, by their signature, attest to its voluntary execution by this child. Witness: __________________________________ Witness: __________________________________ STATEMENT OF PARENT OR RESPONSIBLE ADULT This waiver of counsel was read by me and explained fully to this child in my presence. I understand the right of this child to an attorney and as the of this child I consent to a waiver of this right. Date: ____________________ __________________________________ __________________________________ Waiver Of Counsel {8.933} Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com ---------------------------------------ORDER ASSESSING ATTORNEY'S FEE The child herein, having been represented by the Public Defender in this cause pursuant to Florida Statutes § 27.52, it is ORDERED AND ADJUDGED that a reasonable attorney's fee for services rendered by the Public Defender to the child in this cause is $ and that said fee is hereby assessed against , the father, and , the mother, in favor of the State of Florida. DONE AND ORDERED at _______________________________________ Circuit Judge , Florida, on . Waiver Of Counsel {8.933} Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com