Form 9
QUEENSLAND YOUTH JUSTICE ACT 1992 (Section 36, 37, 38)
Restorative Justice Process Agreement
Date of amendment (if applicable)……/……./…….
The child admits to committing the following offence/s
CONFERENCE / ALTERNATIVE DIVERSION PROGRAM DETAILS
Legislation
Date committed
Referral Number: …………………… Convenor / Case Officer: ……………………………….
Conference / ADP: Date …………………. Place: ……………………………………………….
Referring authority / name:………………………………………………………………………….
DETAILS OF CHILD
Last name: ……………………………..……. First name/s: ……………………………………...
Date of birth ………………………………….
Details of conference agreement or ADP activity
Supervisor
Start Date
End Date
Other comments or information
This agreement / ADP will be finalised by ……../……../…….. Victim/s not in attendance to be advised of outcome (Yes / No) Workplace health and safety issues addressed (Yes / No)
CONVENOR………………………………………….. CHILD………………………… POLICE…………………………VICTIM(S)………………………………………………………………………………………
Privacy notice:
The Department of Justice and Attorney-General is collecting the personal information on this form in order to help in case planning and the administration of your youth justice order/s or interventions under section 289 of the Youth Justice Act 1992. It is also a record of you having been informed
and agreeing to the restorative justice agreement. This is authorised under section 36 and 38 of the Youth Justice Act 1992. This information will also be used to manage your agreement and may be used in relation to breach or variation applications if it is a restorative justice order, or provided to
the court or police for other referrals. This information may also be used for program evaluation or research purposes. Reports of any evaluation or research findings will not contain identifying information.
Some or all of this information may also be provided to a court or tribunal; your parent or carer; Child Safety Services, Department of Communities, Child Safety and Disability Services; your legal representative; the Office of the Director of Public Prosecutions; the Queensland Police.
All other personal information is handled in accordance with Information Privacy Act 2009 (IP Act) and the 11 Information Privacy Principles; except under the circumstance where certain Youth Justice actions are deemed to be a ‘law enforcement’ function for the purposes of section 29(1)(d),
IPP10(1)(d)(i)-(v) and IPP11(1)(d)(i)-(v). For further information about privacy please contact the privacy officer or visit http://www.justice.qld.gov.au/global/legals/privacy
Confidentiality
Information contained on this form is subject to the confidentiality provisions of Part 9 of the Youth Justice Act 1992. Such information may only be used by persons involved in administering the youth justice order to which you are subject. Youth Justice may provide some or all of this information
to those services listed above. This information may also be used by Youth Justice for program evaluation or research purposes. Reports of any evaluation or research findings will not contain any information that could identify you. A person who discloses or uses this information for an improper
purpose may be subject to prosecution and is liable to a maximum penalty of 100 penalty units or 2 years’ imprisonment.
Effective - /08/2016 V2