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Harford County Teen Court Respondent Information Form

  1. Optional Screening for Additional Services:
  2. Is there a history of incarceration in your family?
  3. Have you or someone in your family had to go without food or other physical resources at any point in time?
  4. By filling out this form, you agree to the following:
  5. Parent/Guardian/Respondent Agreement:
  6. We/I the undersigned parent(s)/guardian(s) of the above-named respondent do hereby acknowledge and fully understand that the Harford County Teen Court is an informal adjustment and a voluntary diversion, and that we/I am not obligated to choose Teen Court. We/I understand that the respondent has the right to have this charge heard and decided by the Juvenile Court. The above-named respondent admits that he/she was involved in the offense. We/I understand that our/my child is being referred to a special program and that if he/she cooperates fully, the charge(s) against him/her will not be filed. We/I further understand that the respondent must comply with the sanctions handed down by the Harford County Teen Court, and they must be completed in the time frame assigned to complete the program. We/I understand that failure to comply with these sanctions will result in the case being sent back to the referring agency (Department of Juvenile Services). We/I understand that the Harford County Teen Court Coordinator may send this case back to the referring agency at his/her discretion if it is determined at a later date that the respondent is or has become ineligible. We/I understand that in order to participate in the Harford County Teen Court, the respondent is required to have a mental health and drug/alcohol screening and that all resulting recommendations must be completed for successful completion of the program. The assessment staff and intake staff will share information with each other in order to make the best recommendations possible. We/I understand that the intake and assessment will be held virtually via the WebEx platform and that a secure and private space must and will be provided to ensure confidentiality between the social worker and respondent during the assessment.
  7. Admission Statement
  8. Harford County Teen Court is a diversionary program for youth offenders, between the ages of 11-17, who have been charged with misdemeanor crimes. It provides a non-punitive alternative to a Department of Juvenile Services (DJS) disposition. Upon successful completion of the Teen Court program, the youth offender may avoid a permanent juvenile record for the charge which brings him/her to Teen Court. In order to participate in the Teen Court program, the youth offender must readily admit during intake and at the Teen Court hearing, responsibility in the offense for which he/she is charged. Failure to admit responsibility to the charge will result in the case being referred back to the Department of Juvenile Services.
  9. Statement of Facts
  10. I fully understand that my acceptance into the Harford County Teen Court program requires me to make an admission of responsibility in open court, and failure to do so will result in my case being referred to the Department of Juvenile Services (DJS) for further action. I will be given the opportunity to explain the reasons for my actions, as well as opportunity to explain any mitigating factors during the hearing.
  11. Release of Information Authorization
  12. I authorize Harford County Teen Court to disclose to and/or obtain from: the referring agency, arresting agency, school resource officer, school staff/administrators, and personal counselor, psychiatrist, or treatment provider. Purpose: Coordination of treatment services, including recommendations, attendance and cooperation, and other necessary communication to verify compliance. Revocation: I understand that I have a right to revoke this authorization. Revoking this release of information will not terminate the respondent from the Teen Court program. Expiration: This consent will expire 1 year from the signed date unless otherwise stated. Form of Disclosure: Unless you have specifically requested in writing that the disclosure be made in a certain format, we reserve the right to disclose information as permitted by this authorization in any manner that we deem to be appropriate and consistent with applicable law, including, but not limited to, verbally, in paper format, or electronically
  13. Release of Liability
  14. Hereby acknowledge participation in the Harford County Teen Court Program is voluntary and subject to the conditions imposed by the Program. I have determined that it is in my child’s interest to participate in the Program and I hereby consent to my son/daughter’s participation in the Program. I understand that upon successful completion of the Program, my son/daughter will have the opportunity to avoid a permanent juvenile record concerning the offense for which he/she has been charged. In consideration for participation in the program, I hereby release, hold harmless and indemnify the agents and employees of Harford County, Maryland, the State of Maryland, the Sheriff of Harford County including all of his deputies, as well as any and all volunteers who participate in the Harford County Teen Court Program for any injuries damages, liabilities, claims, arising from participation in the Program.
  15. Leave This Blank:

  16. This field is not part of the form submission.