Hancock County Teen Court Application Form

VOLUNTEER APPLICATION / INFORMATION SHEET

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

Name: ___________________________________________________
Street Address: ___________________________________________

In Case of Emergency
Contact Person: ___________________________________________
Relationship to Applicant: ___________________________________

City: ______________________ State: __________ Zip: ___________

Contact Phone Number: ____________________________________

Address: _________________________________________________
Phone Number: ___________________________________________

Email: ___________________________________________________
How do you prefer to be contacted?

Phone

Text

Age: _______ Date of Birth: _________Sex: MALE

Youth Confidentiality Oath

Email
FEMALE

School You Currently Attend: ________________________________

Grade: (circle one)

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
If yes, when and why? ____________________________

NO

What role are you interested in? (Circle all that apply)
Juror

Prosecuting Attorney

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.

Defense Attorney

Bailiff

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: ____________________________________________________

Court Clerk

Parental Consent
I/We ____________________________________________________
(Parents or Guardians) of ___________________________________,
herby agree to allow him/her to participate in teen court.

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: _____

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 #: ___________________________________________________

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 States
Attorneys 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