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Fill and Sign the Physical Custody Form

Fill and Sign the Physical Custody Form

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Open the document and fill out all its fields.
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Referring Agency Case Number       Intake Case Number       Temporary Physical Custody Request Court Case Number      Requesting Agency Complete Child's/Juvenile's/Expectant Mother's Name (Last, First, Middle)       Date of Birth       Male Female Child's/Juvenile's/Expectant Mother's Address       Telephone Number       County of Residence       Date and Time Taken Into Custody       Why was person taken into custody? (§§48.19, 48.193 48.195 or 938.19) Warrant/capias Order by judge Criminal act Runaway Relinquishment Child/juvenile suffering from illness, injury or other danger Violation of terms of court-ordered supervision Violation of conditions of temporary custody order Violation of civil law or ordinance Unexcused absence from school Serious health risk to unborn childTaken Into Custody By       Agency       Explain:       Legal Father's Name and Address       Home Telephone Number       Work Telephone Number       Legal Mother's Name and Address       Home Telephone Number       Work Telephone Number       Legal Guardian's Name and Address       Home Telephone Number       Work Telephone Number       The parents notified by referring party? Yes (Date and Time)       No Was notification under 48.193(2) given? Yes No Why was person not released?       Intake Worker Complete The parents notified by intake worker? Yes (Date and Time)       No Was notification under 48.193(2) given? Yes No Were rights given? Yes No Jurisdictional Finding: (§48.205 and §938.205) 1. No jurisdiction. 2. Juvenile will commit injury to person or property of others. 3. Person will: cause injury to self. be subject to injury by others. cause serious health risk to unborn child. run away or be taken away so as to be unavailable for further court proceedings. 4. Parent, guardian, legal custodian or other responsible adult is: neglecting refusing unable unavailable to provide adequate supervision and care . Custody decision: 1. Person released. 2. Nonsecure custody: (§48.207 and §938.207) a. At the home of a parent. relative. guardian. person not a relative. b. At licensed foster home, treatment foster home, or group home. c. At non-secure facility operated by a licensed child welfare agency. d. At licensed private or public shelter care facility (including holdover room). e. For expectant mothers at       §48.207(1m). 3. Secure custody because: (§48.208 and §938.208) a. Juvenile has committed a delinquent act and there is a substantial risk of: physical harm to another. runaway. b. Juvenile is a : fugitive from another state. runaway from a juvenile correctional facility. and there has been no reasonable opportunity to return the juvenile. c. A protective order has been issued and the child/juvenile consents in writing to the placement. d. Child/juvenile has run away or committed a delinquent act while in nonsecure placement. e. Juvenile is alleged/adjudicated delinquent and is a runaway from another county and would run away from nonsecure placement. f. Juvenile is subject to the jurisdiction of the adult criminal court and is under 15 years of age. 4. This is a secure custody placement in a jail because: (§48.209 and §938.209) a. No other approved juvenile detention facility is available. b. Child/juvenile is a substantial risk of physical harm to others in a juvenile detention facility. Name of Placement Address       Telephone Number       JD-1710, 08/06 Temporary Physical Custody Request Chapter 48 and 938, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Temporary Physical Custody Request Page 2 of 2 Case No. Special precautions/information concerning child/juvenile/expectant mother       Signature of Intake Worker Date and Time Custody Authorized       Date and Time of Custody Hearing       Date and Time of Release       497431106.doc , 12/02 Temporary Physical Custody Request Chapter 48 and 938, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 2 of 2

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Follow these comprehensive instructions:

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  2. Click +Create to upload a file from your device, cloud storage, or our form library.
  3. Open your ‘Physical Custody’ in the editor.
  4. Click Me (Fill Out Now) to finalize the form on your end.
  5. Add and designate fillable fields for others (if necessary).
  6. Proceed with the Send Invite settings to solicit eSignatures from others.
  7. Download, print your copy, or convert it into a reusable template.

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The best way to complete and sign your physical custody form

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