Fill and Sign the Juvenile and Domestic Relations District Courtjuvenile Form

Rev. 05/2001 JUV-19 __________________ COUNT Y JUVENILE COURT FILED IN THE CLERK'S OFFICE ON THE________ DAY OF __________________________, 20______ . ____________________________________________ CLERK/DEPUTY CLERK ORDER FOR SHELTER CARE IN THE JUVENILE COURT OF ________________________ COUNTY, GEORGIA In the interest of _________________________________________ SEX________________ DOB_________________ A Child FILE #______________ CASE #______________ A complaint has been made to the Court concerning the above-named child. The Court finds from information brought before it that continuation in the home at this time would be contrary to the welfare of said child. It is necessary for the protection of said child th at that he/she be placed in shelter care because ___________________ ____________________________________________________________________________________________ The Court also finds that pursuant to O.C.G.A. §15-11-58(a): ( ) reasonable efforts have been made by the Department to preserve and reunify the family prior to the placement of the child in fo ster care, to prevent or eliminate the need for rem oval of the child from the child's home and to make it possible for said child to remain safely in the home, to wit:_____________ ___________________________________________________________________________________ ___________________________________________________________________________________ ( ) reasonable efforts by the Department to pres erve and reunify the family prior to the placement of the child in foster care, to prevent or eliminate the need for remova l of the child from the child's home and to make it possible for said child to remain safely in the home were not required pursuant to O.C.G.A. §15-11-58 (a)(4) (A-C) because :________________________________________________ ___________________________________________________________________________________ ( ) the Department failed to make reasonable effort s to preserve and reunify the family prior to the placement of the child in fo ster care, to prevent or eliminate the need for rem oval of the child from the child's home and to make it possible for said child to remain safely in the home. The following efforts would have been reasonable to prevent or eliminate the need for removal: ________________________ ___________________________________________________________________________________ IT IS THEREFORE ORDERED that said child be placed in the custody of: _______________________________ until further order of the Court or until released by a person duly authorized by the Court. Said child is being placed pursuant to O.C.G.A. §15-11-46 for the following reasons: ( ) to protect the person or property of others or of the child; ( ) the child may abscond or be removed from the jurisdiction of the Court; ( ) because the child has no parent, guardian, or custodi an or other person able to provide supervision and care for him or her and return him or her to the Court when required; or ( ) an order for the child's detention or shelter care has been made by the Court pursuant to the Juvenile Proceedings Code. Pursuant to O.C.G.A. §15-11-48(f), the Court appr oves the following physical placement of the child: __________ ____________________________ pending the 72 Hour Hearing on ______________________ at ______, ___.m. It is further ordered that the custodian be and hereby is authorized to obtain a physical examination, ordinary medical care, and such additional medical treatment and care which, in the opinion of a licensed physician, requires prompt treatment for the care of the said child while said child is in his/her/its custody. ORDERED AND ADJUDGED this __________ day of ____________________________, 20________. ___________________________________________ Judge/Associate Judge of _______________________ County Juvenile Court