(1) When a law enforcement officer arrests a person for a domestic assault offense or a sexual assault offense, the officer shall, if possible, provide the victim with a printed advisement. Such printed advisement shall include a statement in substantially the following form:

Under Nebraska law, [name of person arrested] is required to avoid contact with you until [date and time of expiration of no-contact period]. [Name of person arrested] is also not allowed to cause any other person to contact you, other than their attorney, your attorney, or a law enforcement officer.

You may agree to waive this protection, and allow [name of person arrested] to contact you. You may do so now by signing this form and returning it to the law enforcement officer. You may also do so later by contacting the officer's law enforcement agency and filling out a written form they will provide.

If you wish to seek continuing protection after [date and time of expiration], you must apply for a protection order from the court. You may seek the advice of an attorney about any matter connected with your application for any future court orders. The attorney should be consulted promptly so that the attorney may assist you in making your application.

(2) Such form may be provided as a separate document or included as part of another document provided to the victim.

(3) Such form may include any other matters as prescribed by the State Court Administrator.

(4) The State Court Administrator shall develop the form required under this section and the written waiver form described in subsection (2) of section 26-203. The administrator shall develop forms in English and may develop forms for other languages spoken by Nebraska residents.