Fill and Sign the Petition Third Party Form

_________ COUNTY JUVENILE COURT FILED IN THE CLERK’S OFFICE ON _____ DAY OF ______________. 20 ____ __________________________________ DEPUTY CLERK IN THE JUVENILE COURT OF ___________ COUNTY STATE OF GEORGIA IN THE INTEREST OF: __________________________ SEX: ___ DOB: __________ CASE # ___________________ __________________________ SEX: ___ DOB: __________ CASE # ___________________ __________________________ SEX: ___ DOB: __________ CASE # ___________________ __________________________ SEX: ___ DOB: __________ CASE # ___________________ Child(ren) Under 18 Years of Age ORDER ON PETITION FOR PLACEMENT WITH A RELATIVE OR OTHER THIRD PARTY UNTIL CHILD(REN) 18 YEARS OF AGE The above and foregoing matter came before the Court on ____________________ for a placement hearing pursuant to O.C.G.A. §15-11-58(i). The Court has previously entered an Order that efforts to reunify the child(ren) with the mother and father should not be made or should be terminated. Based upon the evidence presented, the Court makes the following Findings of Fact and Conclusions of Law by clear and convincing evidence. Any of the “Findings of Fact” herein which should have been properly classified by the Court as “Conclusions of Law” shall be considered as “Conclusions of Law” and any “Conclusions of Law” which should have been properly classified as “Findings of Fact” shall be considered as “Findings of Fact.” FINDINGS OF FACT 1. The child(ren) is/are of the age(s) and sex and has/have the name(s) set forth above. 2. The Court has subject matter jurisdiction over this action and personal jurisdiction over the child(ren), the mother, the father, and the proposed long term custodian(s), ________________________. 3. ( ) Pursuant to O.C.G.A. §15-11-58(p), the child(ren)’s custodian, foster parent(s), preadoptive parent(s), or relative(s) caring for the child(ren), was/were notified of the date and time of the Hearing. 4. Present in Court were: ( ) Mother ______________________ ( ) Attorney _________________________ ( ) Father (Legal) _______________________ ( ) Attorney _________________________ (Putative) _____________________ ( ) Attorney _________________________ ( ) DFACS _______________________ ( ) SAAG ___________________________ ( ) Guardian ad Litem ___________________________ ( ) Other ________________________________________________________________________ The following part(y)(ies) was not/were not present: ___________________________________ He / She / They was (not) / were (not) notified of the proceedings as follows: _____________________________________________________________________________ _____________________________________________________________________________ 5. In accordance with O.C.G.A. §15-11-58(p), the Court considered the oral or written testimony offered by the parent(s), the custodian, the foster parent(s), and/or any preadoptive parents or relatives providing care for the child(ren) along with all testimony and evidence presented in this case. 6. As found in a previous unappealed Deprivation Order and based upon the previous Court hearing granting the Motion of the _____________ County Department of Family and Children Services for Nonreunification with the child(ren)’s mother and father, the child(ren) remain(s) deprived. Efforts to reunify the child(ren) with a parent would be detrimental to the child(ren) and therefore reunification is not in the best interest of the child(ren). 7. Referral for termination of parental rights and adoption is not in the best interest of the child(ren) because _______________________________________________________________________________ 2 ______________________________________________________________________________________ ______________________________________________________________________________________ 8. ( ) Facts which indicate the appropriateness of the proposed placement pursuant to O.C.G.A. Section 15-11-58(i)(1)(A), (B), or (C) are: __________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ( ) There is a compelling reason that a placement pursuant to subsection (A), (B) or (C) of O.C.G.A. Section 15-11-58(i)(1) is not in the best interest of the child(ren), to wit: ____________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ The Court finds that a placement with ____________________________ will provide a family home because of the following characteristics: _____________________________________________________ ______________________________________________________________________________________ 9. ( ) The mother, through her attorney and in open Court, consents to the placement of the child(ren) with the proposed custodian. The father, through his attorney and in open Court, consents to the placement of the child(ren) with the proposed custodian . 10. The Court finds that the _______________ County Department of Family and Children Services has made reasonable efforts to finalize the permanency plan in place. CONCLUSIONS OF LAW AND DISPOSITION The Court has subject matter jurisdiction over this action and personal jurisdiction over the child(ren), the mother, the father and (the relatives or other proposed custodian ) ______________________________________________. 3 These child(ren) is/are (a) deprived child(ren) as defined in O.C.G.A. Section 15-11-2(8)(A) in that he/she/they is/are without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his/her/their physical, mental or emotional health or morals. The Department has made reasonable efforts to finalize the permanency plan in place. The Department’s Petition for permanent placement of the child(ren) with a relative or other third party is HEREBY GRANTED. Pursuant to O.C.G.A. §15-11-58(i), legal custody and control of the above named child(ren) until the child(ren) is/are 18 years of age, is HEREBY AWARDED to __________________________________. Said custodian(s) may not return custody of the child(ren) to any parent or any other person without the written Order of this Court or another Court of appropriate jurisdiction. For Placement of Child(ren) pursuant to O.C.G.A. §15-11-58(i)(1)(D), said agency organization SHALL notify this Court within ten days of its license being placed on probation, suspended, revoked, or surrendered. This Court will thereafter conduct a judicial review within ten days of said notification to determine whether another placement should be made for the child. IT IS FURTHER ORDERED that said custodian(s) is / are authorized to obtain for the child(ren) physical examinations, ordinary medical care and such additional medical treatment and care which, in the opinion of a licensed physician, is necessary for the care and well being of the child(ren). ( ) Within 36 months of this Order and every 36 months thereafter, a probation officer, judicial citizen’s review panel established by the Court, or other person or agency designated by the Court shall, after study and review, submit a report to the Court addressing whether the relative continues to be qualified to receive and care for the children. ( ) Within 12 months of this Order and every 12 months thereafter, a probation officer, judicial citizen’s review panel established by the Court, or other person or agency designated by the Court shall, after study and review, submit a report to the Court addressing whether the non-relative custodian continues to be qualified to receive and care for the child(ren). IT IS SO ORDERED this _____ day of _________________, 20___. ____________________________________ JUDGE ___________ County Juvenile Court 4