Juv # Referral # Diversion Agreement (DAS) - Page 1 of 2 WPF JU 06.0120 (06/2018) - RCW 13.40.080 County Juvenile Court Diversion Agreement (DAS) Name: DOB: Mailing Address: Telephone: ( ) Physical Address: Offense(s): Offense Date: 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 $ for damages/loss/injury incurred by the victim(s), excluding restitution owed to any insurance provider under Title 48 RCW. At the rate of $ per month, by the of each month. My first payment is due by and will be paid in full by . Restitution is joint and several with: Referral # has been equally divided and the amount ordered is my separate obligation, only. Restitution is to be paid through: Physical Address: Mailing Address: Community Restitution: I will perform hours of volunteer work, at a placement approved by the diversion officer. These hours will be completed by . Positive Youth Development/Educational/Information/Restorative Justice Program: I will attend and complete: , by , by The Diversion Unit is not responsible for any cost of counseling, positive youth development 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. Evaluation: I will have an evaluation through , to be completed by . I also agree to follow any recommendation(s) resulting from the evaluation. American LegalNet, Inc. www.FormsWorkFlow.com Juv # Referral # Diversion Agreement (DAS) - Page 2 of 2 WPF JU 06.0120 (06/2018) - RCW 13.40.080 Mandatory 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 Weekends School Attendance at: during required school hours. Restricted from the following locations: Refrain from any contact with the following victims or witnesses: Special instructions: 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: Parent/Guardian: Date: Counselor: CAB Member: CAB Member: CAB Member: CAB Member: CAB Member: CAB Member: American LegalNet, Inc. www.FormsWorkFlow.com