JD-1756, 08/06 Acknowledgment of Dispositional Conditions and Sanctions (Habitual Truancy) 247247938.342(1g) and 938.355(6m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Acknowledgement of Dispositional Conditions and Sanctions (Habitual Truancy) Case No. 1. I am the juvenile. The court has imposed a dispositional order in this case. 2. I have read have had read to me the conditions of that dispositional order. 3. I understand the conditions of the order I must obey. 4. I understand that if I violate the order, the court could order one or more of the following sanctions: Place me in a juvenile detention facility or the juvenile portion of a county jail for up to ten days with educational services. Place me in nonsecure custody for up to ten days with educational services. Suspend or limit my operating privilege (driver's license) for a period of up to one year. Place me under formal or informal supervision for up to one year. Put me in counseling, supervised work program, or other community service. Detain me for not more than 30 days at my home or current residence, except to attend school or church. Place me in an educational program. Make me and/or my guardian pay a forfeiture (fine) of not more than $500 plus costs. Revoke my work permit. Place me in a Teen Court Program. Make me obey other rules or conditions ordered by the court. 5. I understand that if my caseworker is investigating whether I violated the order, my caseworker may, without a hearing, place me for up to 72 hours in nonsecure custody. Caseworker Juvenile Name Printed or Typed Name Printed or Typed Date Date DISTRIBUTION: 1. Juvenile Clerk 2. Caseworker 3. Juvenile/Juvenile's attorney 4. Juvenile's parents American LegalNet, Inc. www.FormsWorkFlow.com