Fill and Sign the Jc 1610 Petition for Protection or Services Chapter 48 Form

JC-1611 , 02/17 Dispositional Order - Protection or Services (Chapter 48) §§48.345, 48.355, 48.356 , 48.78(2)(ag) and (aj), W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 4 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use IN THE INTEREST OF Name Dispositional Order - Protection or Services (Chapter 48) Date of Birth Case No. A petition has been filed with the court. This dispositional hearing was held on [Date ] , which is the effective date of this order. THE COURT FINDS: 1. The child is in need of protection or services because: Coun t Description Wisconsin Statutes Plea Date of Petition 2. The provisions of the Indian Child W elfare Act do not apply. An inquiry has been made on the record to each participant in this proceeding as to whether the participant knows or has reason to know that the child is an Indian child. (For an Indian child who is placed out -of-home, use the Indian Child Welfare Act ver sion (IW -1611) of this order.) 3. The child is placed out -of-home. A. Placement in the home at this time is is not contrary to the child’s welfare . B. Reasonable efforts to prevent removal were [Complete one of the following] made by the department or agency re sponsible for providing s ervices as follows: made by the department or agency responsible for providing services, although an emergency situation resulted in immediate rem oval of the child from the home as follows: not required under §48.355(2d) , W is. Stats., required, but the department or agency responsible for providing services failed to make reasonable efforts. C. Reasonable effo rts to place the child in a placement that enables the siblin g group to remain together were made. not requi red because the child does not have siblings in out -of-home care. not required because it would be contrar y to the safety or w ell being of the child or any of the siblings. Dispositional Order - Protection or Services (Chapter 48) Page 2 of 4 Case No. JC-1611 , 02/17 Dispositional Order - Protection or Services (Chapter 48) §§48.345, 48.355, 48. 356, 48.78(2)(ag) and (aj), W isconsin Stat utes This form shall not be modified. It may be supplemented with additional material. Page 2 of 4 D. Permanency plan was not filed. filed and reasonable efforts to achieve the permanency goal of the permanency plan, including through an out -of-state placement if appropriate, were [Complete one of the following only if a permanency plan was filed ] made by the department or agency responsible for providing services as follows: not made by the department or agency res ponsible for providing services as follows: E. Parent #1 Parent #2 was present and was asked to provide the names and other identifying information of three adult relatives of the child or other adult individuals whose home the parent requests the co urt to consider as placements for the child, unless that information was previously provided. 4. As to t he department or agency re commendation : A. The placement location recommended by the department or agency is adopted. OR B. After giving bona fide co nsideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted. 5. The Statement of Guardian ad Litem was filed. 6. Other: THE COURT ORDERS: 1. The child is placed under court jurisdiction . 2. Placement . A. In-home at . Expiration date of this order [Not to exceed 1 year] . B. Out-of-home at and into the placement and care responsibility of the department in the county where this order is issued, or the Division of Milwaukee Child Pro tective Services if this order is issued in Milwauke e County, which has primary responsibility for providing services. Unless otherwise specified, the expiration date of this order shall be the later of the following:  One year from the date of this order;  The date the child reaches his or her 18 th birthda y;  The date the child is granted a high school or high school equivalency diploma or the date the child reaches his or her 19 th birthday, whichever occurs first, if the child is enrolled fulltime in a secondary school or vocational or technical equivalent and reasonably expected to complete the program prior to age 19;  The date the child is granted a high school or high school equ ivalency diploma or the date the child reaches his or her 21 st birthday, whichever occurs first, if ALL of the following apply:  The child is a fulltime student in secondary school or vocational or technical equivalent.  An individualized education program i s in effect for the child.  The child or guardian, on behalf of the child, agrees to this order.  The child is 17 years of age or older when this order is entered. OR Expiration date of this order . Dispositional Order - Protection or Services (Chapter 48) Page 3 of 4 Case No. JC-1611 , 02/17 Dispositional Order - Protection or Services (Chapter 48) §§48.345, 48.355, 48. 356, 48.78(2)(ag) and (aj), W isconsin Stat utes This form shall not be modified. It may be supplemented with additional material. Page 3 of 4 3. This is an out -of-home placement. The child has one or more siblings in out -of-home care and the child is not placed with all those siblings. The department or agency shall make reasonable efforts to provide frequent visitation or other ongoing interaction between the child and any siblings. is not required to provide for frequent visitation or other ongoing interaction because it would be contrary to the safety or well being of the child or any siblings. 4. Th is is an out -of-home placement and the department or agency shall conduct a diligent search in order to locate and provide notice as required by §48.355(2)(cm) , Wis. Stats., to all adult relatives of the child, including the three adult relatives provided by the parents under §48.335(6), W is. Stats., no later than 30 days from the date of the child ’s removal from the home, unless the search was previously conducted and notice provided. 5. This is an out -of-home placement. If a perman ency plan has been prepared, filed and is consistent with this order , this order contains the plan. Otherwise, a permanency plan consistent with the court’s order shall be filed no later than 60 days from the date of the child’s removal from the home and shall be made part of this order . 6. Conditions of supervision and/or return as follows: See attached 7. Specific s ervices to be provided to child and family as follows: See attached 8. Legal custody transferred to County Department of Human/Social Services. Wisconsin Department of Children and Families. Division of Milwaukee Child Protective Servic es. Other: 9. Special treatment or care as follows: See attached 10. If the child is placed outside of the home, the parent(s) shall provide a statement of income , assets, debts, and living expenses to the county department or agency. A. The parent(s)/guardian shall contribute toward the expenses of cu stody/services in the amount of $ . to be determined by [Agency ] . B. The amount of support to be paid by the parent(s), guardian or trustee fo r the out -of-home placement is $ or % of gross income payable by wage assessment. to be set by the child support agency. The support obligation begins on the date of placement. 11 . The appointment of the gua rdian ad litem for the child terminates until further order of the court. is continued to allow the guardian ad litem to perform any of the du ties under §48.235(4) , W is. Stats . is continued for the following purpose(s): Dispositional Order - Protection or Services (Chapter 48) Page 4 of 4 Case No. JC-1611 , 02/17 Dispositional Order - Protection or Services (Chapter 48) §§48.345, 48.355, 48. 356, 48.78(2)(ag) and (aj), W isconsin Stat utes This form shall not be modified. It may be supplemented with additional material. Page 4 of 4 12 . The appointment of the attorney for the Parent #1 Parent #2 Other: terminates until further order of the court. Parent #1 Parent #2 Other: is continued through the term of this order. Parent #1 Parent #2 Other: is continued for the following purpose(s): 13 . If the child is placed out of the home, the parent(s) who appeared in court have been orally advised of the applicable grounds for termination of parental rights (TPR) and the conditions that are necessary for the child to be returned to the home or restoration of visitation rights. Written TPR warnings are attached. Conditions for return/visitation are part of this order or attached. 14. Upon receiving information that provides reason to know the child is an Indian child, the party shall inform the court. 15. Other: THIS IS A FINAL ORDER FOR PURPOSES OF APPEA L IF SIGNED BY A CIRCUIT COURT JUDGE . BY THE COURT: DISTRIBUTION: 1. Court 2. Child/Guardian ad Litem 3. Parents/Guardian/Legal Custodian 4. Attorney(s) 5. Social Worker/Agency Staff Person 6. Foster Parent/ Physical Custodian 7. District Attorney/Corporation Counsel 8. Court Appointed Special Advocate 9. Other: Circuit Court Judge Circuit Court Commissioner Name Printed or Typed Date NOTICE: If requested by a parent/guardian/legal custodian, child (14 years of age or over) , expectant mother (14 years of age or older) or the guardian ad litem for an unborn child, the agency providing care or services for the child or expectant mother or that has legal custody of the child must disclose to, or make available for inspection, the contents of any reco rds kept or information received by the agency about the child or expectant mother unless the agency determines that imminent danger would result.