Juvenile Records Release

2. Juvenile's Name

   (last, middle, first)

4. Juvenile's Date of Birth
   Juvenile's Date of Birth
6. Juvenile's Address
8. City
9. State
10. Zip Code
12. LDPD Case Number
13. Date of Incident
17. Requester's Information*

    My relationship to the above-named juvenile who is the subject of the records requested

    1. Parent (whose parental rights have not been terminated)
    2. Guardian named by the Court (provide documentation)
    3. Legal Custodian given legal custody by court order (provide documentation)
    4. Juvenile (14 years of age or older) requesting one’s own report
19. Name
20. Email Address
22. Address
24. City
25. State
26. Zip Code
28. Phone Number
30. Date of Form Submission*
    Date of Form Submission

    Date of Form Submission
31. Electronic Signature*

    I hereby authorize the custodian of Lake Delton Police Department Juvenile Records to release the juvenile report involving the above-specified juvenile, subject to departmental policy and approval. This authorization is applicable solely for the release of the above-specified juvenile record. By signing this authorization, I am confirming that it accurately reflects my wishes.

33. Documentation*

    Please upload the juvenile's birth certificate, listing you as his/her parent, or other documentation showing you are a legal custodian or guardian for the juvenile or are otherwise legally entitled to receive these records

34. Persons denied access to juvenile records should contact the Sauk County Clerk of Courts to petition the court for access to the report/records.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field