Fill and Sign the Conditions and Sanctions Form

JD-1756, 08/06 Acknowledgment of Dispositional Conditions and Sanctions (Habitual Truancy) §§938.342(1g) and 938.355(6m), Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Acknowledgment of Dispositional Conditions and Sanctions (Habitual Truancy) Date of Birth Case No. For Official Use 1. I am the juvenile. The court has imposed a dispositional order in this case. 2. I have read have had read to me the conditions of that dispositional order. 3. I understand the conditions of the order I must obey. 4. I understand that if I violate the order, the court could order one or more of the following sanctions: • Place me in a juvenile detention facility or the juvenile portion of a county jail for up to ten days with educational services. • Place me in nonsecure custody for up to ten days with educational services. • Suspend or limit my operating privilege (driver's license) for a period of up to one year. • Place me under formal or informal supervision for up to one year. • Put me in counseling, supervised work program, or other community service. • Detain me for not more than 30 days at my home or current residence, except to attend school or church. • Place me in an educational program. • Make me and/or my guardian pay a forfeiture (fine) of not more than $500 plus costs. • Revoke my work permit. • Place me in a Teen Court Program. • Make me obey other rules or conditions ordered by the court. 5. I understand that if my caseworker is investigating whether I violated the order, my caseworker may, without a hearing, place me for up to 72 hours in nonsecure custody. Signature of Caseworker Signature of Juvenile Name Printed or Typed Name Printed or Typed Date Date Distribution: 1. Original - Juvenile Clerk 3. Juvenile/Juvenile's attorney 2. Caseworker 4. Juvenile's parents