Name: ___________________________________________________

Street Address: ___________________________________________

City: ______________________ State: __________ Zip: ___________

Contact Phone Number: ____________________________________

Email: ___________________________________________________

How do you prefer to be contacted? Phone Text Email

Age: _______ Date of Birth: _________Sex: MALE FEMALE

School You Currently Attend: ________________________________

Grade: (circle one) 9 10 11 12

How did you learn about Teen Court? (Circle all that apply) School Friend Newspaper Court Radio Other __________

Have you been involved with Teen Court before? YES NO If yes, when and why? ____________________________ What role are you interested in? (Circle all that apply) Juror Prosecuting Attorney Defense Attorney Bailiff Court Clerk

In Case of Emergency

Contact Person: ___________________________________________

Relationship to Applicant: ___________________________________

Address: _________________________________________________

Phone Number: ___________________________________________

Youth Confidentiality Oath I solemnly swear that I will not divulge, either by words or signs, any

information about actual cases that comes to my knowledge in the

course of a teen court presentation, and that I will keep secret all

said proceedings that may be held in my presence.

Further, I understand that if I break confidentiality by telling anyone

else the names of teen court offenders or any other specific details

of the case that may identify that juvenile, I will no longer be able to

serve as a teen court participant.

Applicant Signature: _______________________________________

Date: ____________________________________________________

Hancock County Teen Court Application Form

VOLUNTEER APPLICATION / INFORMATION SHEET

Please fill out all of the information completely. PRINT LEGIBLY.

Parental Consent

I/We ____________________________________________________

(Parents or Guardians) of ___________________________________,

herby agree to allow him/her to participate in teen court.

Liability Waiver

It is further agreed and understood, that as condition of participation

in the teen court program, I/We promise to hold harmless the teen

court board of directors, committee, coordinator, employees,

volunteers, and school district in Hancock County and its’ employees,

duly authorized law enforcement officers in any municipality in

Hancock County, any community service organization/agency and its’

employees, news media and their employees, and churches/ministers

from any and all actions, causes of action, or any claims whatsoever,

which may arise out of participation in any activities of the Hancock

County Teen Court Program, including coming and going.

Parent/Guardian Signature: __________________________________

Date: (month/day/year) _____________________________________

Phone #: _________________________________________________

Cell #: ___________________________________________________

Consent to Use Photographs

Hancock County Teen Court may periodically have photographers

from county staff and/or media entities, or other parties take

photographs for use in news stories, program literature or other

purposes. Please initial below if you consent to having pictures taken:

Your photograph taken and used: _____

Your name used in the caption of a photo: _____

Thank you for interest in serving on the Hancock County Teen Court.

You will be getting notices for future court dates and events. Please

turn this application in to your school principle, mail to the address

below, scan and email it or drop it off at the Hancock County State’s

Attorney’s Office in Carthage.

If you have any questions, please do not hesitate to contact me at:

Phoebe Wilson

Hancock County Teen Court Coordinator Hancock County Courthouse

P.O. Box 420, 500 Main Street

Carthage, IL 62321

Phone: 815-973-7549

Email: hcoteencourt@gmail.com