Fill and Sign the Informal Disposition Agreement Wisconsin

State of Wisconsin Circuit Court Informal Disposition Agreement 1. Intake Case Number       In the interest of: (In Need of Protection or Services) 2. County       Name of Child       4. Date of Birth       5. Child’s Address       Zip Code       6. Date Referral Received       An inquiry has been conducted into this matter. It has been determined that at this time neither the interests of the child named above nor of the public require filing of a petition for circumstances relating to §48.13, Wisconsin Statutes. It is this intake worker's belief, however, that the facts are sufficient that court action could be sought, and this conclusion is undisputed by the child and parents, guardian or legal custodian . 7. Summary of Undisputed Facts:       8. Obligations - Check all appropriate boxes for any combination of obligations A. Case held open for       months or until .       . Date B. No new referrals to intake. C. Counseling: Child Parent/guardian Family Terms:       D. A.O.D.A. Assessment: Terms:       E. Parent participation in parenting skills training F. Youth participation in a court approved pupil assistance program G. Curfew:       H. Daily school attendance; no unexcused absences; obey school rules I. Other specific obligations/conditions:       The child and parents, guardian and legal custodian are notified of their right to object at any time to the facts or terms of this agreement. If there are objections, the intake worker may alter the terms of the agreement or recommend that a petition be filed. This agreement may be terminated at any time upon the request of the child, parents, guardian or legal custodian. If the informal disposition is terminated, the intake worker may recommend to the district attorney/corporation counsel that a petition be filed. If at any time during the period of this agreement the intake worker determines that the stated obligations are not being met, the intake worker may cancel this agreement and recommend that a petition be filed. Upon agreement of all parties the Informal Disposition Agreement may be extended up to 6 months. The district attorney or corporation counsel may file a petition within 20 days after receipt of this agreement. Filing of a petition will cancel this agreement. JC-1607 , 05/00 Informal Dispositional Agreement (In Need of Protection or Services) §48.245, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Informal Dispositional Agreement (In Need of Protection or Services) Page 2 of 2 Case No. 9. Date Agreement Effective       10. Date Agreement Terminates       Print or Type Names Signatures Date Signed Child             Father/Guardian/Legal Custodian             Mother             Intake Worker             JC-1607 , 05/00 Informal Dispositional Agreement (In Need of Protection or Services) §48.245, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 2 of 2