JV-451 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: PRISONER'S STATEMENT REGARDING APPEARANCE AT HEARING AFFECTING PARENTAL RIGHTS 1. CASE NUMBER: I have read and understand, or I have had explained to me and I understand, the Order for Prisoner's Appearance at Hearing Affecting Parental Rights (form JV-450) that accompanies this form. I understand that a hearing regarding my rights, responsibilities, and relationship to the following children (names): 2. will be held on (date): located at at (time): the court address above in Dept.: other (specify address): Room: Phone: 3. I understand that the hearing is set to a. b. c. consider a petition to declare the child a dependent of the court under Welfare and Institutions Code section 300, which may limit my rights to the care, custody, and control of my child. terminate my parental rights and select and implement a permanent plan of adoption for my child. Other (specify code section and hearing purpose): . Right to attorney 4. I understand that I have a right to be represented by an attorney at the hearing. a. b. c. I already have a juvenile dependency attorney who will represent me at this hearing. I want a juvenile dependency attorney appointed to represent me at this hearing. I do not want to be represented, and I give up my right to be represented by an attorney at this hearing. Page 1 of 3 Form Adopted for Mandatory Use Judicial Council of California JV-451 [New January 1, 2012] PRISONER'S STATEMENT REGARDING APPEARANCE AT HEARING AFFECTING PARENTAL RIGHTS Penal Code, § 2625 Cal. Rules of Court, rules 5.530(f), 5.531 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-451 CASE NAME: CASE NUMBER: Right to be physically present You have the right to be physically present at the hearing described in items 2 and 3. If you give up the right to be physically present at that hearing, and either the court does not permit you to appear and participate by videoconference or telephone or the institution cannot accommodate your appearance and participation by videoconference or telephone, the court may proceed without you. 5. I understand that I have a right to be physically present at the hearing described in items 2 and 3. a. b. I want to be physically present at that hearing. I will need the assistance of an interpreter (specify language): I do not want to be physically present at the court and I give up that right. Request to appear by videoconference or telephone If you have given up the right to be physically present at the hearing described in items 2 and 3, you may ask the court to let you appear and participate in the hearing by videoconference or telephone. 6. I do not want to be physically present at the hearing described in items 2 and 3, and (check all that apply): a. b. I understand that both the institution and the court have the equipment to allow me to appear and participate in the hearing by videoconference or telephone. I understand that either the institution or the court does not have the equipment to allow me to appear and participate by videoconference or telephone. I understand that this means that I will not be able to appear and participate by telephone. I want to participate in the hearing by videoconference or telephone. I will need the assistance of an interpreter (specify language): d. I do not want to participate in the hearing by videoconference or telephone. c. Date: (TYPE OR PRINT NAME) (SIGNATURE OF PARENT) DECLARATION OF TRANSLATOR (To be completed if prisoner does not understand English sufficiently to read this form.) Spanish other (specify): 7. a. The prisoner's primary language is b. I certify that I translated Order for Prisoner's Appearance at Hearing Affecting Parental Rights (JV-450) and this form for the prisoner in the prisoner's primary language to the best of my ability. Date: (TYPE OR PRINT NAME) (SIGNATURE OF INTERPRETER) JV-451 (New January 1, 2012) PRISONER'S STATEMENT REGARDING APPEARANCE AT HEARING AFFECTING PARENTAL RIGHTS Page 2 of 3 JV-451 CASE NAME: CASE NUMBER: DECLARATION OF OFFICIAL 8. This institution a. can provide the prisoner with videoconference technology that complies with Cal. Rules of Court, rule 5.531. b. c. can provide the prisoner with telephonic technology that complies with Cal. Rules of Court, rule 5.531. cannot provide the prisoner with videoconference or telephonic technology that complies with Cal. Rules of Court, rule 5.531. To the official: Complete item 9 only if the prisoner has not completed items 1­6, above. 9. The prisoner (name): has expressly stated to me has by the following conduct expressly indicated to me (describe conduct): that he or she (check all that apply): a. b. c. does not want to attend the hearing and waives the right to be physically present. wants to appear and participate by videoconference or teleconference. does not want to participate in the hearing in any way. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE) (TITLE OF OFFICIAL) IMPORTANT: PLEASE READ A copy of this form must be provided by the clerk, social worker, or, if the court has not ordered the parent's appearance, parent's attorney of record to the parent and the warden or other person in charge of the institution where the parent is confined not less than 15 days before the scheduled hearing. This form must then be completed by the parent, interpreter, and person in charge of the institution, as appropriate, then filed with the court by the person in charge of the institution and returned to the parent's attorney of record not less than 8 court days before the scheduled hearing. JV-451 (New January 1, 2012) PRISONER'S STATEMENT REGARDING APPEARANCE AT HEARING AFFECTING PARENTAL RIGHTS Page 3 of 3