ADDENDUM TO ADMISSION COLLOQUY FORM 

In re __________________

Docket # __________________ 

(Juvenile) 

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Delinquent Act(s): _________ 
_________________________ 
_________________________ 
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ELIGIBILITY FOR CIVIL COMMITMENT FOR INVOLUNTARY TREATMENT 

CIVIL COMMITMENT CASES 

I did at least one of the crimes (in the box below); AND 

If the judge says that I am a delinquent; AND 

If I am in placement when I turn age 20, 

I can go to a different placement against my will.   

See 42 Pa.C.S. § 6401 et seq. 

Check all that are true: 

 Rape, 18 Pa.C.S. § 3121

 Sexual Assault, 18 Pa.C.S. § 3124.1

 Involuntary Deviate Sexual

 Indecent Assault, 18 Pa.C.S. § 3126

Intercourse, 18 Pa.C.S. § 3123

 Aggravated Indecent Assault,

 Incest, 18 Pa.C.S. § 4302

18 Pa.C.S. § 3125

If I am in placement when I am age 20, SOAB (State Sexual Offenders
Assessment Board) will look at information about me to see if I have mental
problems that make it hard for me to stop doing sexual crimes.  ________ initials

If SOAB thinks that I need treatment, the judge will have a hearing.
________ initials

See 42 Pa.C.S. § 6358. 

See 42 Pa.C.S. § 6358. 

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If the judge agrees I need treatment, I will have a second hearing.
________ initials

See 42 Pa.C.S. § 6358. 

At the hearing, the judge will decide if I have mental problems that make it likely
that I will do sexual crimes again.  If the judge says yes:

a) I will go to a different placement for at least one year.  ________ initials

See 42 Pa.C.S. §§ 6403 & 6404. 

b) I will be required to register as a sex offender under the Sex Offender

Registration and Notification Act.  ________ initials

See 42 Pa.C.S. § 9799.13(9). 

c) If and when I am released from this different placement, I must register with
the state police and report to them every 90 days for at least 25 years.  It is
a crime not to register and report to the state police.  Information about me
and my crime will also be available for everyone to to see on the internet.
________ initials

See 42 Pa.C.S. §§ 9799.15(a)(5), (a.2) & 9799.15(b)(1)(iii); 18 Pa.C.S. § 
4951.1

d) If I am released from this different placement and continue to register and

report to the state police and I do not commit any more serious crimes for at
least 25 years, I can ask the judge whether I can stop registering and
reporting to the state police. ________ initials

See 42 Pa.C.S. § 9799.15(a.2).

The judge will look at my case each year.  I will stay in that placement for as long
as the judge decides that I have mental problems that make it likely that I will do
sexual crimes again.  ________ initials

If the judge says I can leave placement, I must continue to get treatment when
told for my mental problems.  The judge will look at my case after one year.
________ initials

See 42 Pa.C.S. §§ 6404.1 & 6404.2. 

If the judge says I can stop getting treatment after one year, I still must talk to a
counselor every month. ________ initials

See 42 Pa.C.S. §§ 6404.1 & 6404.2. 

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If I do not obey these rules or the counselor says I cannot stop my bad actions, I
will be sent back to placement.   ________ initials

          See 42 Pa.C.S. § 6404.2.

Lawyer’s Representation and Opportunity to Speak with Guardian 

9)

Did you talk with your lawyer before you decided to tell the judge you did the 
crimes (delinquent acts)?     Yes     No

10)

Are you okay with what your lawyer did for you?       Yes     No

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Did your lawyer answer all your questions?      Yes     No

12)

Did you talk with your parent or guardian about saying you did the crimes?

     Yes      No

If you answered no, would you like to talk with them now?    Yes      No

I have read this form or someone has read this form to me. 

I understand the form and what I have to do.  The signature below and initials on each 
page of this form are mine. 

___________________________________________ 
JUVENILE 

___________________________________________ 
DATE 

I, ______________________, lawyer for the juvenile, have reviewed this form with my 
client.  My client has informed me and I believe that he or she understands the rights, 
consequences, and dispositions outlined in this form. I have completed the foregoing 
sections with my client.  I have explained them.  I have no issues with my client 
admitting to the delinquent acts. 

____________________________________________ 
LAWYER FOR JUVENILE  

____________________________________________ 
DATE 

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