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JD -1 71 2, 0 4/0 8 W aiv e r o f P artic ip atio n in N onse cu re P hys ic a l C usto d y H earin g §§4 8.2 1(3 )(a m ), 9 3 8.2 1(2 )(a m ), 9 3 8.2 1 (3 )(a m ), W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 1 o f 1 S TA TE O F W IS C O NSIN , C IR CUIT C O URT, C O UNTY IN T H E IN TE R EST O F N am e W aiv e r o f P artic ip atio n in N onsecu re P hys ic al C usto d y H earin g D ate o f B ir th C ase N o. F or O ffic ia l U se I a m th e ju ve n ile : 1. in vo lv e d in th is p ro ce edin g, a lle g ed t o b e d e li n qu ent, a nd h eld in n o nse cu re c u sto dy. 2. in vo lv e d in th is p ro ce edin g, a lle g ed t o b e a h ab it u ally tr u ant f r o m h om e, a nd h eld in n o nse cu re c u sto d y. 3. u nder a ge 1 0, in vo lv e d in th is p ro ce edin g, a lle g ed t o h ave c o m m it te d a d e li n qu ent a ct, a n d h eld in n onse cu re c u sto d y. I a m th e p are n t/g u ard ia n/le gal c u sto dia n/I n d ia n c u sto d ia n o f th e: 1. c h ild in n e ed o f p ro te ctio n o r s e rv ic e s in vo lv e d in th is p ro ce edin g w ho is b e in g h e ld in a n onse cu re c u sto dia l p la ce m ent. 2. ju ve n il e in n e ed o f p ro te ctio n o r s e rv ic e s in vo lv e d in th is p ro ce ed in g w ho is b e in g h eld in a n onse cu re c u sto dia l p la ce m ent b eca use : · th e p are nt o r g u ard ia n s ig n ed th e p etit io n r e q uestin g ju ris d ic tio n; · th e ju ve n il e is h ab it u ally tr u ant f r o m s c h ool; · th e ju ve n il e is a s ch oo l d ro pout; o r · th e ju ve n il e is n ot r e sp onsib le f o r a d elin que nt a ct b y r e aso n o f m enta l d is e ase o r d efe ct. The c h ild /ju ve nile is h e ld a t: I u nd ers ta nd th at I: · have th e r ig ht t o a tt e n d th e h earin g in c o urt o n w he th er th is p la ce m ent s h ou ld c o ntin u e. · have th e r ig ht t o h ave a n a tto rn e y a t s u ch a h earin g if I a m th e ju ve n il e c h arg ed. · am g iv in g u p m y r ig ht t o p artic ip ate in a h e arin g a t t h is tim e, b ut I a ls o u nd ers ta nd th at I c a n r e q uest a h earin g o n p la ce m ent a t a n y f u tu re t im e f o r g ood c a use . I a m w aiv in g t h e r ig ht to p a rtic ip ate in a n o nse cu re p hys ic a l c u sto d y h earin g. Sig natu re o f P are n t/G ua rd ia n/L eg al C usto dia n/In dia n C usto dia n Nam e P rin te d o r T yp ed Sig natu re o f J u ve nil e Nam e P rin te d o r T yp ed Date Date D is tr ib utio n: 1 . Court - O rig in al 2 . Dis tr ic t A tto rn ey/C orp ora tio n C ounse l 3 . Pare nts /G uard ia n/L egal C usto dia n/In dia n C usto dia n 4 . Child /J u ve nile 5 .