Parent / Guardian Name

Youth Respondent Name

Your Role

explain your role if you are a support person

Respondent's Interests - What does your child like to do in his or her spare time? What activities does this person find interesting, entertaining or worth their time?

Respondent's Strengths and Aptitudes - At what activities does your child show aptitude or strengths? Any particular subjects in school? Art, music, sports, family responsibilities, community responsibilities, positive or supportive personality traits or relationships, others

Negative Impact of this incident on Respondent - Your child was referred for a criminal or prohibited behavior. Please describe any negative impact that this incident has had on your child in terms of harmed relationships with family or community, missed school, justice system contact, punishment or any other negative effects

Negative impact this incident has had on parents, family members, or others - Please describe any impact this incident has affected you as a parent or family member. How has this incident affected you? How has it affected your family? How did you feel when you learned about the incident? How has it impacted your relationship with your child? any other impact you'd like to list

Positive Impact of this incident on Respondent - Please describe any positive impact this incident may have had on your child, including improved understanding of the impact of their actions, positive behavioral changes, or any other positive effects that may have resulted

What has the Respondent done to repair harm caused by this incident? - Please describe any actions that your child has already taken to repair harm caused by this incident, including making apologies, returning or repairing property, etc.

Conclusion/ other statements - How do you think this issue should be resolved in a way that repairs relationships and community? Is there anything else you would like the Peer Court to consider