CONFIDENTIALITY WAIVER
I, (name of respondent): ,do hereby acknowledge and understand that as a juvenile I have a right of confidentiality with respect to the nature and extent of the crime to which I have admitted guilt.
I further acknowledge that in order to participate in San Francisco Peer Court, information as to the nature and extent of my involvement in the crime charged and events at issue must be released to third parties, including, but not limited to, staff, adult attorneys, youth attorneys, jurors, bailiffs, clerks and other observers and participants involved in the Teen Court process.
By
signing this I agree to waive my right to confidentiality with respect to
information regarding the crime to which I have admitted guilt. This waiver pertains to information contained
in the police report, portions of which may be given to the above-named
individuals, school attendance records and grade reports, testimony that I
and/or my parent/guardian supply during the
This waiver does not apply to personal health information and other records which by law are protected from disclosure unless I specifically authorize the disclosure of such records in writing. This waiver also does not apply to information obtained by the Peer Court/Intake staff unless I specifically authorize the release of such information either in writing or verbally.
I have read and understand the above confidentiality waiver.