Fill and Sign the California Removal Form

JV-420 CHILD'S NAME: CASE NUMBER: ––––– ––––– DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT—PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) 1. The child is a person described under Welf. & Inst. Code, § 300 (specify all that apply): 300(a) 300(c) 300(e) 300(g) 300(i) 300(b) 300(d) 300(f) 300(h) 300(j) and is adjudged a dependent of the court. Circumstances justifying removal from custodial parent 2. There is clear and convincing evidence of the circumstances stated in Welf. and Inst. Code, § 361 regarding the persons specified below (check all that apply): 361(c)(1) 361(c)(2) 361(c)(3) 361(c)(4) 361(c)(5) a. Mother b. Presumed father c. Biological father d. Alleged father e. Legal guardian f. Indian custodian g. Other (specify): 3. The child is may be an Indian child, and, by clear and convincing evidence, continued physical custody by the following person is likely to cause the child serious emotional or physical damage: Mother Biological father Legal guardian Presumed father Alleged father Indian custodian Other (specify): ––––– 4. Reasonable efforts were were not made to prevent or eliminate the need for the child's removal from the home. 5. The child is may be an Indian child, and, a. by clear and convincing evidence, active efforts were made to provide remedial services and rehabilitative programs designed to prevent the breakup of this Indian family, and those efforts were unsuccessful. b. active efforts were not made to provide remedial services and rehabilitative programs designed to prevent the breakup of this Indian family. Custody of the child and services 6. Physical custody is removed from (specify all that apply): mother biological father legal guardian other (specify): ––––– presumed father alleged father Indian custodian Page 1 of 4 Form Approved for Optional Use Cal. Rules of Court, rule 5.695 Judicial Council of California Welfare and Institutions Code, §§ 361, 361.2 JV-420 [Rev. January 1, 2007] electronic form ã 2005-7 WWW.LawCA.co m Law Publishers DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT—PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) JV-420 CHILD'S NAME: CASE NUMBER: ––––– ––––– 7. Noncustodial parent a. The mother presumed father biological father other (specify): ––––– was not residing with the child at the time that the events or conditions arose that brought the child within the provisions of Wel. & Inst. Code, § 300 and desires custody of the child. Placement with this parent would not be detrimental to the safety, protection, or physical or emotional well-being of the child. b. The child will benefit from the provision of reunification services to the biological father. c. The parent indicated in item 7a is granted physical and legal custody of the child pursuant to the custody order and final judgment entered this day. Visitation with the child is as stated in the Visitation Order—Juvenile (form JV-205) . The clerk of the juvenile court must file with the family court a completed Custody Order—Juvenile Final–Judgment (form JV-200) and Visitation Order—Juvenile (form JV -205) . d. The child is placed with the parent indicated in item 7a, subject to the supervision of the juvenile court and the county agency. (1) Reunification services are provided to the person from whom the child was removed, the mother presumed father biological father other (specify): ––––– who is ordered to participate in the services set forth in the case plan. Family maintenance services are not ordered for the parent indicated in item 7a. (2) Family maintenance services are provided to the parent indicated in item 7a to allow that parent to retain later custody without court supervision. The parent is ordered to participate in the services set forth in the case plan. Reunification services are not ordered for the person from whom the child was removed. (3) Reunification services are provided to the person from whom the child was removed, the mother presumed father biological father other (specify): ––––– and family maintenance services are provided to the parent indicated in item 7a. The parents are ordered to participate in the services set forth in the case plan. The court will determine at a scheduled court hearing which parent, if either, will have custody of the child without court supervision. e. The factual basis for the findings in this item 7 is stated on the record. 8. The mother is incarcerated and is seeking to participate in the Department of Corrections community treatment program. a. Participation in the program is is not in the child's best interest. b. The program is is not suitable to meet the needs of the mother and child. JV-420 [Rev. January 1, 2007] DISPOSITIONAL ATTACHMENT: REMOVAL FROM Page 2 of 4 CUSTODIAL PARENT—PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) JV-420 CHILD'S NAME: CASE NUMBER: ––––– ––––– Siblings 9. The child does not have siblings under the court's jurisdiction. 10. The child does have siblings under the court's jurisdiction. a. The nature of the relationship between the child and the child's siblings is (1) stated on the record. (2) described in the social worker's report. (3) other (specify): ––––– b. (1) Developing or maintaining the sibling relationship with the siblings named below is appropriate. (a) (name): ––––– (d) (name): ––––– (b) (name): ––––– (e) (name): ––––– (c) (name): ––––– (f) (name): ––––– (2) Developing or maintaining the sibling relationship with the siblings named below is not appropriate. (a) (name): ––––– (d) (name): ––––– (b) (name): ––––– (e) (name): ––––– (c) (name): ––––– (f) (name): ––––– (3) The basis for the finding in this item b. is (a) stated on the record. (b) described in the social worker's report. (c) other (specify): ––––– c. The impact of the sibling relationships on the child's placement and planning for legal permanence is (1) stated on the record. (2) described in the social worker's report. (3) other (specify): ––––– 11. The child and all of the child's siblings under the court's jurisdiction are placed together in the same home. 12. The child and all of the child's siblings under the court's jurisdiction are not placed together in the same home. a. Efforts are being made to place the child and the following siblings together. (1) Child's siblings: (a) (name): ––––– (d) (name): ––––– (b) (name): ––––– (e) (name): ––––– (c) (name): ––––– (f) (name): ––––– (2) The reasons the child and these siblings are not placed together and the efforts being made to do so are (a) stated on the record. (b) described in the social worker's report. (c) other (specify): ––––– b. Efforts to place the child with the following siblings are not appropriate . (1) Child's siblings: (a) (name): ––––– (b) (name): ––––– (c) (name): ––––– (2) The reasons that efforts to place the child with these siblings are not appropriate are (a) stated on the record. (b) described in the social worker's report. (c) other (specify): ––––– c. The frequency and nature of the visitation between the child and child's siblings who are not placed together are (1) stated on the record. (2) described in the social worker's report. (3) other (specify): ––––– JV-420 [Rev. January 1, 2007] DISPOSITIONAL ATTACHMENT: REMOVAL FROM Page 3 of 4 CUSTODIAL PARENT—PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) JV-420 CHILD'S NAME: CASE NUMBER: ––––– ––––– Education 13. The mother presumed father biological father other (specify): ––––– must ensure the child's regular school attendance and make reasonable efforts to obtain the education services necessary to meet the child's specific needs. 14. The right of the mother biological father legal guardian presumed father alleged father Indian custodian other (specify): ––––– to make educational decisions for the child is limited as set forth in the Order Limiting Parent's Right to Make Educational Decisions for the Child and Appointing Responsible Adult as Educational Representative–Juvenile, (form JV-535) filed in this matter. Advisement 15. At the next status review hearing custody may be given to the parent with whom the child is currently placed and the jurisdiction of the court dismissed. If the child is removed from the parent with whom the child is currently placed and ordered placed in foster care, the case may be referred to a selection and implementation hearing under Welf. & Inst. Code, § 366.26. The selection and implementation hearing could result in the termination of parental rights and the adoption of the child. JV-420 [Rev. January 1, 2007] DISPOSITIONAL ATTACHMENT: REMOVAL FROM Page 4 of 4 CUSTODIAL PARENT—PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2)