• State seal of Ohio

    Summit County Juvenile Court

    Responder Referral
  • Has the Child's Family Been Made Aware of this Referral?

  • Family must be notified prior to making a Responder Referral. Please complete that step prior to completeing this form.

  • Child's Date of Birth:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Presenting Concerns (Choose all that apply)
  • Has the Resource Officer intervened as a result of youth's behavior?
  • Should be Empty: