State of Alabama Unified Judicial System Form JU-7E Authorization of Shelter/Other Care Rev. 06/11 Case Number IN THE JUVENILE COURT OF __________________________________________________ COUNTY, ALABAMA (Name of County) In the Matter of ______________________________________________________________________________, a child TO _____________________________________________________: (Name of Shelter/Other Care Facility) I am a duly designated juvenile court intake officer. Pursuant to §12-15-127(b), based on an allegation of dependency child in need of supervision / status offender (pursuant to §12-15-208), I have reviewed the written notice of the person taking the above-named child into custody without an order of the juvenile court and have determined that shelter/other care is required for the following reason(s): The child has no parent, legal guardian, legal custodian or other suitable person able to provide supervision and care for the child. The release of the child would present a clear and substantial threat of a serious nature to the person or property of others and where the child is alleged to be delinquent. The release of the child would present a serious threat of substantial harm to the child. The child has a history of failing to appear for hearings before the juvenile court. The above-named child is to be delivered to _______________________________________________________________ (Name of Shelter/Other Care Facility) by ________________________________________for admission/placement. (Person/Agency taking child into custody) ____________________________ Date ____________________________________________ Intake Officer Part II TO PARENT/LEGAL GUARDIAN/LEGAL CUSTODIAN To question continuing detention of your child, you must appear at the hearing to be held at______________________________ ____________________________________ on (date) ________________ at _______________ time and date to be determined later. (You will be notified) DESCRIPTION OF CHILD Part III Sex _________________ Height _______________ DOB _____________ Eyes _________________ Race ________________ Weight ______________ Hair ______________ Marks ________________ Address ______________________________________________________________________________ _____________________________________________________________________________________ Part IV PERSON TAKING CHILD INTO CUSTODY I certify that I have delivered the above-named child to _____________________________________________, and that I have (Name of Shelter/Other Care Facility) delivered a copy of this authorization to ___________________________________________. (Name of person accepting custody at Shelter/Other Care Facility) ____________________________________________ Signature ____________________________ Date P art V CUSTODY RECEIPT I certify that I have received custody of the above-named child. ___________________________ Date ____________________________________________ Signature of Person Receiving Custody Ala. Code 1975, §§12-15-12 7(b); 12-15-128 COURT RECORD: (Original) PARENT/LEGAL GUARDIAN/LEGAL CUSTODIAN: (Copy) INTAKE OFFICER: (Copy) FACILITY: (Copy) American LegalNet, Inc. www.FormsWorkFlow.com