CONSENT TO INFORMAL ADJUSTMENT

The undersigned child and the parents, guardian or other custodian of the child, having read the Informal Adjustment:

1. Admit that said child is subject to the jurisdiction of the Juvenile Court by reason of the conduct recited therein which is hereby admitted;

2. Agree that counsel, advice, and conditions for the conduct and control of the child without an adjudication would be in the best interest of the public and the child; and

3. Consent to said Informal Adjustment for the period of time prescribed, knowing that we do not have the consent.

We understand that a violation of the Informal Adjustment may result in the filing of a formal Petition and a hearing before the Juvenile Court.

We further acknowledge receiving a copy of the Informal Adjustment and agree to comply with the enforce compliance with the conditions therein imposed.

Dated this day of , 19 .

Child

Parent or Guardian