Fill and Sign the Law Enforcement Agency Form

JV-635SUPERIOR COURT OF CALIFORNIA, COUNTY OF FOR COURT USE ONLYSTREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: PROMISE TO APPEAR —JUVENILE DELINQUENCY(Juvenile 14 Years or Older)LAW ENFORCEMENT AGENCY: REPORT NUMBER: Name of child: Date of birth of child: Address of child: Phone number of child: Name of parent, legal guardian, or adult relative: Address of parent, legal guardian, or adult relative (if different from that of child ): Phone number of parent, legal guardian, or adult relative (if different from that of child): 1. I have been arrested for one or more of the following felony offenses (list code violations alleged): 2. The police officer probation officeris releasing me to (name): who is my mother father legal guardian relative (state relationship): 3. I PROMISE TO APPEARon (date): at (time): in Dept.: Room: located at courthouse address above other (specify address): 4. I understand that if I do not come to court on the date and at the time indicated, the court may order that a warrant be issued for my arrest.Date: (TYPE OR PRINT NAME) (SIGNATURE OF CHILD) (TYPE OR PRINT NAME) (SIGNATURE OF PARENT LEGAL GUARDIAN RELATIVE)Witnessed by: (TYPE OR PRINT NAME) (SIGNATURE OF PROBATION OFFICER POLICE OFFICER (agency): Request for AccommodationsAssistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the proceeding. Contact the clerk's office or go to www.courtinfo.ca.gov/forms for Request for Accommodations by Persons With Disabilities and Order (form MC-410). (Civil Code, § 54.8.)Page 1 of 1Form Adopted for Mandatory Use PROMISE TO APPEAR—JUVENILE DELINQUENCY Welfare and Institutions Code, § 629Judicial Council of CaliforniaJV-635 [Rev. January 1, 2006] (Juvenile 14 Years or Older)• ORIGINAL —Transmitted to court • Copy to youth • Copy to parent, guardian, or relative • Copy to probationelectronic form  2005 WWW.LawCA.com Law Publishers