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Fill and Sign the Wisconsin Physical Custody Form

Fill and Sign the Wisconsin Physical Custody Form

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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name Order for Temporary Physical Custody Secure Nonsecure       Date of Birth Case No.       A request for temporary physical custody has been filed with the court. A hearing for temporary physical custody was held on       , which is the effective date of this order. THE COURT FINDS the child/juvenile is in the jurisdiction of this court and probable cause exists to believe that the: 1. Juvenile will commit injury to person or property of others. 2. Child/juvenile will cause injury to self. be subject to injury by others. 3. Parent, guardian, legal custodian or other responsible adult is neglecting refusing unable unavailable to provide adequate supervision and care. 4. Child/juvenile will run away or be taken away, making the child/juvenile unavailable for further court proceedings. 5. Child/juvenile is not subject to the federal Indian Child Welfare Act. 6. Parent has relinquished custody of the child. For secure custody, the court further finds that probable cause exists to believe that: 1. The juvenile has committed a delinquent act and there is a substantial risk of physical harm to another. running away. 2. The juvenile is a fugitive from another state runaway from a juvenile correctional facility, and there has been no reasonable opportunity to return the juvenile. 3. A protective order has been issued and the child/juvenile consents in writing to the custody. 4. The child/juvenile has run away or committed a delinquent act while in nonsecure custody. 5. The juvenile is alleged/adjudicated delinquent and is a runaway from another county and would run away from nonsecure custody. 6. The juvenile is subject to adult criminal court jurisdiction and is under 15 years of age. For secure custody in a jail, the court further finds that: 1. No other juvenile detention facility approved by DOC or the county is available. 2. The juvenile presents a substantial risk of physical harm to others in the juvenile detention facility. For all custody outside of the home, the court further finds that: 1. Continuation of residence in the home at this time is contrary to the child’s/juvenile’s welfare because:       2. Reasonable efforts to prevent removal and return child/juvenile safely home were: (Complete one of the following.) made by the department or agency responsible for providing services in the following manner:       not possible due to the following emergency situation:       JD-1711 , 08/06 Order for Temporary Physical Custody – Secure/Nonsecure §§48.19(1), 48.21, 48.205, 48.415(1m), 48.355(2d), 938.19(1), 938.205, 938.21, 938.355(2d), Wis. Stats. This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 Order for Temporary Physical Custody – Secure/Non-Secure Page 2 of 2 Case No. not required under §§48.355(2d) and 938.355(2d) because:       required, but good cause has been shown why sufficient information is not available to enable the court to make the necessary findings. This hearing is continued until (date):       not to exceed 5 days required, but the department or agency responsible for providing services failed to make reasonable efforts. 3. As to the department or agency recommendation: a. The placement location recommended by the department or agency is adopted. OR b. After giving bona fide consideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted. THE COURT ORDERS: 1a. The child/juvenile be held in temporary secure custody at:       OR 1b. The child/juvenile be held in temporary nonsecure custody at:       2. While in a nonsecure placement above, the child/juvenile shall also be monitored by an electronic monitoring system. 3. Other conditions of custody:       4. The parent(s)/guardian shall contribute toward the expenses of custody/services in the amount of $       to be determined by (agency):       . 5. Transportation to the placement and any return to court shall be provided by:       6. The next hearing date is       at       a.m. p.m. 7. The petition for temporary physical custody is denied. Name and Address of Placement:       Distribution: 1. Original - Court 2. Placement Facility 3. Child/Juvenile/Parents/Attorneys 4. Social Worker/Intake Worker BY THE COURT: Circuit Court Judge/Circuit Court Commissioner       Name Printed or Typed       Date JD-1711 , 08/06 Order for Temporary Physical Custody – Secure/Nonsecure §§48.19(1), 48.21, 48.205, 48.415(1m), 48.355(2d), 938.19(1), 938.205, 938.21, 938.355(2d), Wis. Stats. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2

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