Approved, SCAO WAIVER AND CONSENT TO ENTER TEEN COURT (DIVERSION) Name Charge(s) Date and time to appear Location We [juvenile and parent(s) or guardian(s)] have been informed and understand 1. that we could have had an attorney present to advise us during the conference at which we signed this Waiver and Consent. 2. that the Teen Court is a voluntary program offered as an alternative to formal proceedings and the charges against me [the juvenile]. 3. that if we fail to appear at the location named above at the stated time, our participation in the program will be terminated and the charge(s) will be processed formally by the appropriate court. 4. that, to be eligible to participate in the program, I [the juvenile] must admit responsibility for the charge(s), and must agree to satisfy the conditions imposed by the program. 5. that the conditions imposed by the program may include, but are not limited to: curfew, restitution, community service, counseling, victim reconciliation, participation in therapeutic programs, participation in educational programs, obtaining and maintaining employment, and writing reports and theme papers. 6. that those conditions imposed by the program will be stated in a written diversion agreement authorized by MCL 722.825. 7. that a failure to comply with any of the conditions imposed by the program will be a violation of the agreement and may result in the filing of a petition for formal court processing of the charges. 8. that we may appeal any decision made by the program coordinator by submitting a written statement of our reasons for appealing within 14 days after we are notified of the Teen Court's decision. We agree to release, hold harmless, and indemnify the following persons and entities for all claims or causes of action arising from our participation in the Teen Court program: the Teen Court, the Family Division of the Circuit Court, the School District, all other entities affiliated with Teen Court, and also their employees, students, and volunteers, including all persons and entities involved in the work detail and community service elements of the program. We have made a voluntary decision to particiate in the Teen Court program. We have not been coerced or influenced by any representation or statement not contained in this document. We have read this entire document, understand its contents, and agree to abide by all of its stated conditions. Date Signature of juvenile Signature of parent/guardian Signature of parent/guardian Witnessed by: Signature of probation officer JC 78 (9/07) WAIVER AND CONSENT TO ENTER TEEN COURT (DIVERSION) American LegalNet, Inc. www.FormsWorkflow.com