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CHILD’S NAME: CASE NUMBER: The child has suffered, or there is a su bstantial risk that the child will suffer, serious physical harm or illness, as a result of the failure or inability of his or her parent or legal guardian to supervise or protect the child adequately. as a result of the willful or negligent fa ilure of the child’s parent or legal guar dian to supervise or protect the child adequ ately from the conduct of the custodi an with whom the child has been left. by the willful or negligent failure of the parent or legal guardian to provide the child with adequate food, clothing, shelter, or medical treatment. by the inability of the parent or legal guardian to provide regul ar care for the child due to the parent’s or legal guardian's mental illness, developmental disability, or substance abuse. (State supporting facts concisely and number them b-1, b-2, b-3, etc.): of Page Welfare and Institutions Code, § 300; Cal. Rules of Court, rule 5.504 www.courtinfo.ca.gov FAILURE TO PROTECT § 300(b) Form Approved for Optional Use Judicial Council of California JV-121 [Rev. January 1, 2007] FAILURE TO PROTECT § 300(b) JV-121

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