City of Victoria Form Center

2. Juvenile/Defendant Name*

   First and Last Name

4. Address*

   Address Line 1

6. Address

   Address Line 2

8. City*
9. State*
10. Zip Code*
12. Juvenile Phone Number*
13. Juvenile Email Address*

    May be the same as the Parent/Guardian e-mail below

15. Do you or the parent/guardian need an interpreter?*

    1. Yes
    2. No
16. If an interpreter is needed, please select which language.
    -- Select One --SpanishVietnameseChineseFrenchGermanPortugueseOther
17. If other, please identify which language.
19. Parent/Guardian Name*

    First and Last Name

20. Parent/Guardian E-mail*
22. Parent/Guardian Phone Number*
23. Parent/Guardian's Preferred Method of Contact*

    1. Telephone Number (Listed Above)
    2. E-mail
25. Intake Appointment

    Prior to your hearing before the Judge, the juvenile case manager will schedule an intake appointment with you and your parent or guardian. Please select which time of day works best for you and your parent or guardian so that the juvenile case manager can assist in scheduling you for a time that works best for you. You may also select an in-person option, a virtual one where all parties are virtual, or a hybrid format where some are in-person and some are virtual. 

27. Please select the best time of day. *

    1. Mornings
    2. Lunchtime
    3. Afternoons
28. Intake Appointment Type*

    1. In-person
    2. Virtual
    3. Hybrid
30. Virtual Meeting or Hearing

    If attending a virtual hearing or meeting, a website link will be sent to you. You will need to have audio and video capabilities on your device. Please test your device at https://zoom.us/test if you are unsure if you have these capabilities. 

31. Do you have the ability to attend a virtual meeting or hearing?*

    1. Yes
    2. No
33. Upload ID or DL of Juvenile or Parent/Guardian*
34. Any Additional Documentation
36. Please provide any additional information or any questions you may have. *
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field