A waiver containing the following statements and in substantially the following form shall be read by, signed by, and a copy given to a juvenile who waives the right to consult with a lawyer before an initial interview with a diversion unit:
Waiver of Lawyer
Dated _____________________________ Dated _________________________
Parent or Guardian (optional) _____________________________ Juvenile _____________________________
The above statement was read to the juvenile and signed by the juvenile on the date indicated.
_____________________________
Representative of Diversion Unit
Wash. Juv. Ct. R. JuCR 6.3