JV-417 CHILD'S NAME: CASE NUMBER: DISPOSITIONAL ATTACHMENT: IN-HOME PLACEMENT WITH FORMAL SUPERVISION (Welf. & Inst. Code, § 361) 1. The child is a person described by Welf. & Inst. Code, § 300 (check all that apply): 300(a) 300(c) 300(e) 300(g) 300(i) 300(b) 300(d) 300(f) 300(h) 300(j) and is adjudged a dependent of the court. The county agency is ordered to immediately return the child to the legal guardian mother biological father presumed father Indian custodian other (specify): were were not made to prevent or eliminate the need for removal from the home. 2. 3. Reasonable efforts Case plan development 4. a. b. The county agency solicited and integrated into the case plan the input of the representative of child's identified Indian tribe other (specify): The county agency did not solicit and integrate into the case plan the input of the representative of child's identified Indian tribe other (specify): The county agency did not solicit and integrate into the case plan the input of the representative of child's identified Indian tribe other (specify): child child mother mother father . father , father , and the agency is ordered to do so and submit an updated case plan within 30 days of the date of this hearing. c. child mother and the county agency is not required to do so because these persons are unable, unavailable, or unwilling to participate. Custody of the child 5. Custody of the child is retained by mother biological father presumed father Indian custodian other (specify): 6. The child and the mother presumed father other (specify): biological father Indian custodian legal guardian legal guardian are placed under the supervision of the county agency. Family maintenance services 7. The county agency must provide, and the mother biological father presumed father Indian custodian other (specify): legal guardian must participate in, family maintenance services designed to keep the family together as specified in the family's case plan. Page 1 of 2 Form Approved for Optional Use Judicial Council of California JV-417 [Rev. July 1, 2011] DISPOSITIONAL ATTACHMENT: IN-HOME PLACEMENT WITH FORMAL SUPERVISION (Welf. & Inst. Code, § 361) Welfare and Institutions Code, § 361; Cal. Rules of Court, rules 5.651 and 5.695 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-417 CHILD'S NAME: CASE NUMBER: Education 8. a. A limitation on the right of the parents to make educational decisions for the child is not necessary. The parents hold educational rights and responsibilities in regard to the child's education, including those described in rule 5.650(e)­(f) of the California Rules of Court. A copy of rule 5.650(e)­(f) may be obtained from the court clerk. A limitation on the right of the parents to make educational decisions for the child is necessary, and those rights are limited as stated in Findings and Orders Limiting Right to Make Educational Decisions for the Child, Appointing Educational Representative, and Determining Child's Educational Needs (form JV-535) filed in this matter. The educational rights and responsibilities of the educational representative are described in rule 5.650(e)­(f) of the California Rules of Court. A copy of rule 5.650(e)­(f) may be obtained from the court clerk. are are are are are not are not are not are not being met. being met. being met. being met. b. 9. a. The child's educational needs b. The child's physical needs c. The child's mental health needs d. The child's developmental needs 10. The additional services, assessments, and/or evaluations the child requires to meet the unmet needs specified in item 9 or other concerns are: a. b. stated in the social worker's report. specified here: 11. The following persons are ordered to take the steps necessary for the child to begin receiving the services, assessments, and/or evaluations identified in item 10: Social worker a. b. c. d. e. Parent (name): Surrogate parent (name): Educational representative (name): Other (name): 12. The mother presumed father biological father Indian custodian legal guardian other (specify): must ensure the child's regular school attendance and make reasonable efforts to obtain the education services necessary to meet the child's specific needs. JV-417 [Rev. July 1, 2011] DISPOSITIONAL ATTACHMENT: IN-HOME PLACEMENT WITH FORMAL SUPERVISION (Welf. & Inst. Code, § 361) Page 2 of 2