ADMISSION COLLOQUY FORM
In re | : | ___JD___ | |
(Juvenile) | : | ||
Delinquent Act(s):____ | |||
: | _________________ | ||
: | _________________ | ||
: | _________________ |
Answer all of the questions on this form. If you do not understand any question, leave it blank and ask your lawyer or the judge.
I admit that I did the following things (attorney shall list the delinquent acts, grading of acts, and counts):
_________________________________________________________
_________________________________________________________
_________________________________________________________
General Information:
If yes, state:_____________________
If so, who?_________________ (print name)
______________
(signature of reader verifies that the form has been read to the juvenile)
If so, who?____________________ (print name)
_______________________________________________________
(signature of reader verifies that the form has been read to the juvenile)
Knowing and Voluntary Admission:
If yes, specify type of drugs and/or alcohol:__________
If yes, explain:_______________________________
If yes, explain:____________________
Understanding the Admission:
Possible Consequences of Adjudication of Delinquency:
(lawyer shall write acts on this line, cross off, or write n/a).
Admission Agreements:
Appeals:
If you do not admit, do you understand you have other rights?____
Lawyer's Representation and Opportunity to Speak with Guardian
I promise that I have read the whole form or someone has read the form to me. I understand it. I am telling the truth. I am saying that I have done the things on page 1. I believe that this admission is best for me. The signature below and initials on each page of this form are mine.
______________
JUVENILE
______________
DATE
I, _________, lawyer for the juvenile, have reviewed this form with my client. My client has told me and I believe that he or she understands this form.
_________________________
LAWYER FOR JUVENILE
________________________
DATE
ADDENDUM TO ADMISSION COLLOQUY FORM
In re | : | ____ JD____ |
(Juvenile) | : | |
: | Delinquent Act(s):____ | |
: | _______________ | |
: | _______________ | |
: | _______________ |
ELIGIBILITY FOR CIVIL COMMITMENT FOR INVOLUNTARY TREATMENT
Civil Commitment Cases
I did at least one of the crimes (in the box below); AND
If the judge says that I am a delinquent; AND
If I am in placement when I turn age 20,
I can go to a different placement against my will.
See42 Pa.C.S. § 6401et seq.
Check all that are true:
[] Rape, 18 Pa.C.S. § 3121 | [] Sexual Assault, 18 Pa.C.S. § 3124.1 |
[] Involuntary Deviate Sexual Intercourse, 18 Pa.C.S. § 3123 | [] Indecent Assault, 18 Pa.C.S. § 3126 |
[] Aggravated Indecent Assault, 18 Pa.C.S. § 3125 | [] Incest, 18 Pa.C.S. § 4302 |
See42 Pa.C.S. § 6358.
See42 Pa.C.S. § 6358.
See42 Pa.C.S. § 6358.
See42 Pa.C.S. §§ 6403 & 6404.
See42 Pa.C.S. § 9799.13(9)
See42 Pa.C.S. §§ 9799.15(a)(5), (a.2) & 9799.15(b)(1)(iii); 18 Pa.C.S. § 4951.1.
See 42 Pa.C.S. § 9799.15(a.2).
See42 Pa.C.S. § 6404.
See42 Pa.C.S. §§ 6404.1 & 6404.2.
See42 Pa.C.S. §§ 6404.1 & 6404.2.
See42 Pa.C.S. § 6404.2.
Lawyer's Representation and Opportunity to Speak with Guardian
If you answered no, would you like to talk with them now? [] Yes [] No
I have read this form or someone has read this form to me.
I understand the form and what I have to do. The signature below and initials on each page of this form are mine.
______________
JUVENILE
______________
DATE
I, ___________, lawyer for the juvenile, have reviewed this form with my client. My client has informed me and I believe that he or she understands the rights, consequences, and dispositions outlined in this form. I have completed the foregoing sections with my client. I have explained them. I have no issues with my client admitting to the delinquent acts.
____________________
LAWYER FOR JUVENILE
____________________
DATE
237 Pa. Code r. 407