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ADDENDUM TO ADMISSION COLLOQUY FORM
In re __________________
:
Docket # __________________
(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.
See 42 Pa.C.S. § 6401 et 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
1) If I am in placement when I am age 20, SOAB (State Sexual Offenders
Assessment Board) will look at information about me to see if I have mental
problems that make it hard for me to stop doing sexual crimes. ________ initials
See 42 Pa.C.S. § 6358.
2) If SOAB thinks that I need treatment, the judge will have a hearing.
________ initials
See 42 Pa.C.S. § 6358.
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3) If the judge agrees I need treatment, I will have a second hearing.
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See 42 Pa.C.S. § 6358.
4) At the hearing, the judge will decide if I have mental problems that make it likely
that I will do sexual crimes again. If the judge says yes, I will go to a different
placement for at least one year. ________ initials
See 42 Pa.C.S. §§ 6403 & 6404.
5) The judge will look at my case each year. I will stay in that placement for as long
as the judge decides that I have mental problems that make it likely that I will do
sexual crimes again. ________ initials
See 42 Pa.C.S. § 6404.
6) If the judge says I can leave placement, I must continue to get treatment when
told for my mental problems. The judge will look at my case after one year.
________ initials
See 42 Pa.C.S. §§ 6404.1 & 6404.2.
7) If the judge says I can stop getting treatment after one year, I still must talk to a
counselor every month. ________ initials
See 42 Pa.C.S. §§ 6404.1 & 6404.2.
8) If I do not obey these rules or the counselor says I cannot stop my bad actions, I
will be sent back to placement. ________ initials
See 42 Pa.C.S. § 6404.2.
Lawyer’s Representation and Opportunity to Speak with Guardian
9) Did you talk with your lawyer before you decided to tell the judge you did the
crimes (delinquent acts)? Yes No
10) Are you okay with what your lawyer did for you? Yes No
11) Did your lawyer answer all your questions? Yes No
12)
Did you talk with your parent or guardian about saying you did the crimes
Yes No
If you answered no, would you like to talk with them now? Yes No
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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
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