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____________ COUNTY JUVENILE COURT FILED IN THE CLERK'S OFFICEON ____ DAY OF _______________, 20___ . CLERK/DEPUTY CLERK IN THE JUVENILE COURT OF _______________ COUNTY STATE OF GEORGIA IN THE INTEREST OF:__________________________________ SEX: ____ DOB: ______________ CASE # __________________________________________________________ SEX: ____ DOB: _____________CASE # __________________________________________________________ SEX: ____ DOB: _____________CASE # __________________________________________________________ SEX: ____ DOB: _____________ CASE # ________________________Child(ren) Under 18 Years of Age ORDER FOR SHELTER CARE A complaint has been made to the Court concerning the above-named child(ren). The Court finds from information brought before it that continuation in the home at this time would be contrary to the welfare of said child(ren) and it is necessary for the protection of said child(ren) that that he/she/they be placed in shelter care because _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The Court also finds that pursuant to Official Code of Georgia Ann. Section 15-11-58(a):( ) reasonable efforts have been made by the Department to preserve and reunify the family prior to the placement of thechild(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the child(ren)’s home and to make it possible for said child(ren) to remain safely in the home, to wit: ________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________ ( ) reasonable efforts by the Department to preserve and reunify the family prior to the placement of the child(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the child(ren)'s home and to make it possible for said child(ren) to remain safely in the home were not required pursuant to O.C.G.A. Section 15-11-58 (a)(4) (A-C) because: ___________________________________________________________________________________________( ) the Department failed to make reasonable efforts to preserve and reunify the family prior to the placement of the child(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the child(ren)'s home and to make it possible for said child(ren) to remain safely in the home. The following efforts would have been reasonable to prevent or eliminate the need for removal: _________________________________________________________________________ IT IS THEREFORE ORDERED that said child(ren) be placed in the custody of _____________________________________ until further Order of the Court or until released by a person duly authorized by the Court. Said child(ren) is/are being placed pursuant to Official Code of Georgia Ann. Section 15-11-46 for the following reasons: ( ) to protect the person or property of others or of the child(ren);( )the child(ren) may abscond or be removed from the jurisdiction of the court;( )because he/she/they has/have no parent, guardian, or custodian or other person able to provide supervision and care for him/her/them and return him/her/them to the Court when required; ( )an Order for his/her/their detention or shelter care has been made by the Court pursuant to the Juvenile Proceedings Code. Pursuant to O.C.G.A. Section 15-11-48(f), the Court approves the following physical placement of the child(ren):________________________________________________ pending the 72 Hour Hearing on __________________________ at ____________, ____.m.It is further ordered that the custodian be and hereby is authorized to obtain a physical examination, ordinary medical care, and such additional medical treatment and care which, in the opinion of a licensed physician, requires prompt treatment for the care of said child(ren) while said child(ren) is/are in his/her/its custody.ORDERED AND ADJUDGED this _______ day of __________________________, 20____. JUDGE ______________ County Juvenile Court