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 SOLANO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: 600 Union Avenue P.O. Caller 5000 Fairfield, CA 94533 321 Tuolumne Street 321 Tuolumne Street Vallejo, CA 94590 CHILD'S NAME: Child's Date of Birth: APPLICATION AND DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT WITHOUT A COURT ORDER (Welfare & Institutions Code § 827, California Rules of Court, rule 5.552) CASE NUMBER: I, 1. , declare as follows: I am entitled to inspect and receive copies of the juvenile court case file concerning the above-named child without a court order because I am (check one): A district attorney, city attorney, or city prosecutor authorized to prosecute criminal or juvenile cases under state law. [WIC §827(a)(1)(B)] The minor who is the subject of the juvenile proceeding. [WIC §827(a)(1)(C)] A parent or guardian of the minor. [WIC §827(a)(1)(D)] An attorney for the minor who is actively participating in criminal or juvenile proceedings involving the minor. [WIC §827(a)(1)(E)] An attorney for the parent or guardian of the minor who is actively participating in criminal or juvenile proceedings involving the minor. [WIC §827(a)(1)(E)] An attorney representing the petitioning agency in a dependency action. [WIC §827(a)(1)(E) & (F)] A probation officer actively participating in criminal or juvenile proceedings involving the minor. [WIC §827(a)(1)(E)] A social worker or investigator employed by a child protective agency. [WIC §272(a)(1) & 827(a)(1)(E) & (H)] A law enforcement officer, other than a deputy sheriff or city police officer, who is actively participating in criminal or juvenile proceedings involving the minor. [WIC §827 (a)(1)(E)] A probation officer who receives mandated reports of suspected child abuse or neglect pursuant to county designation. [WIC §827(a)(1)(H) & PC §11165.9] A State Department of Social Services employee engaged in the oversight and monitoring of county child welfare agencies, foster care assistance, and/or out-of-state placements. [WIC §827(a)(1)(I)] A Court Appointed Special Advocate (CASA). [WIC §827(a)(1)(A) & 103(h)] APPLICATION AND DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT WITHOUT A COURT ORDER Solano County Local Form No. 898 ­ Rev. 07/01/12 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CHILD'S NAME: CASE NUMBER: 2. I am entitled to inspect the juvenile court case file concerning the above-named child, but not receive copies of the file, without a court order because I am (check one): A superintendent or designee of the school district where the minor is enrolled or attending school. [WIC §827(a)(1)(G)] A State Department of Social Services legal staff or special investigator peace officer engaged in the inspection, licensing and investigation of community care facilities. [WIC §827(a)(1)(J)] A person, agency, or member of a multidisciplinary team providing treatment or supervision of the minor. [WIC §827(a)(1)(K)] A family court mediator actively participating in a family law case involving the minor. [WIC §827(a)(1)(L)] A child custody evaluator actively participating in a family law case involving the minor. [WIC §827(a)(1)(L)] An attorney appointed for the minor in a family law case. [WIC §827(a)(1)(L)] A probate court investigator actively participating in a guardianship case involving the minor. [WIC §827(a)(1)(M)] A local child support agency employee or child support commissioner engaged in establishing paternity and/or establishing and enforcing child support. [WIC §827(a)(1)(N)] A juvenile justice commissioner appointed pursuant to Welfare and Institutions Code §225. [WIC §827(a)(1)(O)] 3. I further declare: a. I am requesting to view (and receive copies, if applicable) of the juvenile case file concerning the above-named minor for use in my capacity described above. I will not share any portion of the records released to me or ] information relating to their contents, other than as provided by law. [Initial: b. I will not attach any portion of the juvenile case file or any information relating to the contents of the juvenile case file to any other document without the prior approval of the Presiding Judge of the Juvenile Court, unless they are used in connection with and in the course of a criminal investigation or prosecution, a proceeding to declare a person a dependent child or ward of the Juvenile Court, or a proceeding described in Welfare and ] Institution Code section 827(a)(1)(I) by the State Department of Social Services. [Initial: c. Designation of Authorized Agent: I authorize as my agent to view and/or receive copies of the requested records. The authorized agent shall be subject to the same ] confidentiality requirements set forth above. [Initial: I declare under penalty of perjury under the laws of the State of California that the forgoing is true and correct. Date: Signature: Title (if applicable): State Bar No. (Attorneys): For Clerk's Use Only GRANTED Date: By: Related (non-juvenile) Case No.: DENIED Badge No. (Law Enforcement): Agency Case No.: APPLICATION AND DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT WITHOUT A COURT ORDER Solano County Local Form No. 898 ­ Rev. 07/01/12 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com