Fill and Sign the Forms and Instructions Virginias Judicial System

PETITION AND ORDER FOR P ARE NTAL PARTI CIP ATION Case No . .................................................... Common wealth of Virginia Va. Code §§ 16.1-241.2, 22.1-27 9.3 ........................................................................\ DATE OF HEAR ING ........................................................................\ ............................................. Juvenile and Do mestic Rela tio ns District Co urt ........................................................................\ ...... v. ........................................................................\ ............ PETITIONER/SCHOOL BOAR D RESPONDENT/P ARENT/GUAR DIAN/ LEGAL CUSTODIAN .............................................................................. ............................................... .................................... ADDR ESS ADDR ESS ........................................................................\ ...... ................................................................................... .............................................................................. ............................................... .................................... TELEPHO NE NUM BER TELEPHO NE NUM BER ........................................................................\ ...... ........................................................................\ ........... NAME OF S TUDE NT RESPONDENT’S DATE OF BIRTH .............................................................................. ............................................... .................................... ADDR ESS RESPONDENT’S SOCIAL SECURITY N UMBER .............................................................................. STUDENT’S DATE O F BIRTH STUDENT’S SOCI AL SECUR ITY NUM BER Th e scho ol bo ard fo r ........................................................................\ ................... hereb y petition s this court to pro ceed ag ainst the p aren t named ab ov e for willfu l and unreaso nable refu sal to particip ate i n effo rts t o imp rov e th e stud ent’s behavior. Th e sc hool boa rd speci fically request s that: [ ] The c ourt order the pa rent to meet wi th sch ool officials to discuss t he st udent’s i mpro vement in be havior, sc ho ol attendance or edu cation al prog ress, th e sch ool board’s stan dards of st ud ent con duct, an d th e paren t’s resp on sibility to assist th e sch ool in disci plin ing the stud ent, m aintain ing ord er, or en suring the ch ild’s scho ol atten dance. [ ] Th e cou rt im pose a civ il p enalty n ot to exceed $500 .00 fo r the p arent’s fai lure t o m eet with sc ho ol officials d ue to the s tude nt’s sus pensi on or expulsion. [ ] The c ourt order the student or pa rent to part icipate in such program s or such t reat ment as t he c ourt dee ms appro priate to improv e t he student’s behavi or. ........................................................................\ ....................................................... ............................................... [ ] The c ourt order the student or pa rent to be s ubject to the cond itio ns and limitatio ns as t he court deem s appropriate for the superv ision , care, and reh abilitatio n of t he st udent or his paren ts. ........................................................................\ ....................................................... ............................................... ................................................ ____ ___ ___ ___ ______ ___ ___ ___ ______ ___ ___ ___ ______ ___ ___ ___ ____ DATE PETI TIONER ’S S IGNA TURE Sw orn/A ffirm ed a nd sig ned before m e on ............................................................... ___ _ ____ _ INTA KE OF FICER ____ _____ _____ _____ ______ ___ ___ ___ ______ ___ ___ ___ ____ FORM DC- 560 (PAGE ONE OF TWO) 07/04 PDF SUGGESTED PROGRAM NAME AND ADDRESS SUGGESTED CONDITIONS AND LIMITATIONS FORM DC-560 (PAGE TWO OF TWO) 07/04 PDF ORDER ........................................................................\ ............ PETITIONER/SCHOOL BOARD V. ........................................................................\ ............ RESPONDENT/PARENT/GUARDIAN/LEGAL CUSTODIAN The court hereby orders: [ ] a civil fine of $ ....................................................... to be paid to ........................................................................\ .. [ ] The parent(s) to meet with school officials; [ ] The [ ] student and/or [ ] parent to participate in the following program or treatment: .......................................................................\ ....................................................... ................................................ PROGRAM NAME AND ADDRESS .......................................................................\ ....................................................................................................... [ ] The [ ] student and/or [ ] parent to be subject to the following conditions and limitations: .......................................................................\ ....................................................................................................... CONDITIONS AND LIMITATIONS .......................................................................\ ....................................................................................................... .......................................................................\ ....................................................................................................... ................................................ ______________________________________________________________ DATE JUDGE