ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

JV-622

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

TELEPHONE NO.: 

                 
E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD'S NAME:

INFORMAL PROBATION AGREEMENT

CASE NUMBER:

This agreement is a CONTRACT between the probation officer, the above named child, and his or her parent or parents or legal 
guardian.

The agreement is for up to six (6) months, and during that period and for up to 90 days after that, the probation officer has the right to 
request that the district attorney file a petition in juvenile court to have the child declared a ward of the court if the child does not 
successfully complete the terms of the program described below.  If within the first 60 days after this agreement is signed, the child 
does not become involved in the program, the probation officer MUST take the necessary steps to bring the case before the juvenile 
court.

TERMS AND CONDITIONS OF THE PROGRAM 

The child must (check all that apply to this child):

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Report to the probation officer

times each month until or unless directed differently.

Obey all city, county, state, and federal laws and ordinances.

Obey his or her parent or parents or legal guardian.

Attend school regularly, obey school rules and regulations, and not leave the school campus during school hours without 
permission of school officials or the probation officer.

Not use, possess, or be under the influence of any alcoholic beverage or illegal or intoxicating substance, or possess any 
associated paraphernalia.

Not use, possess, or be under the influence of the following (specify):

Not possess, own, or handle any firearm, knife, weapon, fireworks, explosives, or chemicals that can produce explosives.

Not contact or associate with

Not be a member or associate with any known members of any criminal street gang.

Participate in individual, group, or family counseling, as directed by the probation officer.

Submit to chemical testing in the form of, but not limited to, blood, breath, urine, or saliva on the direction of the probation 
officer or a peace officer.

Consent to the search of his or her person, vehicle, or place of residence at any time, day or night, with or without a search 
warrant and without probable or reasonable cause, on the direction of the probation officer or a peace officer.

Perform

hours of community service and provide proof of completion by (date):

.

.

.

Community service to be arranged

a.

b.

by the child with the approval of the probation officer.

through the probation officer.

Form Approved for Optional Use 
Judicial Council of California 
JV-622 [New January 1, 2006]

INFORMAL PROBATION AGREEMENT

Page 1 of 2

www.courtinfo.ca.gov

CHILD'S NAME:

CASE NUMBER:

JV-622

Be at his or her place of residence between the hours of ____________ p.m. and ___________ a.m. unless with a parent or 
legal guardian or with the prior permission of the probation officer.

(cid:96)

(cid:96) (cid:96) (cid:96)

I have read and understand the terms and conditions.  I consent to them and promise to follow them and to cooperate with the 
probation officer.  I understand that if I do not follow the terms and conditions, I may have to go to juvenile court.  I have received a copy 
of this agreement.

(TYPE OR PRINT CHILD'S NAME)

(SIGNATURE OF CHILD)

I am the
cooperate with the probation officer and to assist the child to follow the terms and conditions.

legal guardian of the child, and he or she has agreed to the terms of this agreement.  I agree to 

parent

(TYPE OR PRINT NAME)

(SIGNATURE OF PARENT/LEGAL GUARDIAN)

(TYPE OR PRINT NAME)

(SIGNATURE OF PARENT/LEGAL GUARDIAN)

(TYPE OR PRINT NAME)

(SIGNATURE OF PARENT/LEGAL GUARDIAN)

JV-622 [New January 1, 2006]

INFORMAL PROBATION AGREEMENT

Page 2 of 2

14.

15.

16.

17.

18.

19.

20.

Date:

Date:

Date:

Date: