COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .____________ COUNTY JUVENILE COURT ......... .. FILED IN THE CLERK'S OFFICE : ON ____ DAY OFNo. Index _______________, 20___ . : CLERK/DEPUTY Calendar No. CLERK IN THE JUVENILE COURT OF _______________ COUNTY : STATE OF GEORGIA JUDICIAL Plaintiff(s) IN THE INTEREST OF: -against- SUBPOENA : __________________________________ SEX: ____ DOB: ______________ CASE # ________________________ : __________________________________ SEX: ____ DOB: _____________ CASE # ________________________ __________________________________ SEX: ____ DOB: _____________ CASE # ________________________ Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEX:.____ . .DOB:. _____________ ... ... ... ........ __________________________________ CASE # ________________________ : Child(ren) Under 18 Years of Age ORDER FOR SHELTER CARE A complaint has been THE the Court concerning the above-named child(ren). The Court finds from information brought before it THE PEOPLE OFmade toSTATE OF NEW YORK that continuation in the home at this time would be contrary to the welfare of said child(ren) and it is necessary for the protection of said child(ren) that that he/she/they be placed in shelter care because ___________________________________________________ TO ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ The Court also finds that pursuant to Official Code of Georgia Ann. Section 15-11-58(a): GREETINGS: efforts have been made by the Department to preserve and reunify the family prior to the placement of the ( ) reasonable child(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the child(ren)’s home and to make itCOMMAND YOU, that all businessin the excuses wit: ________________________________________ before WE possible for said child(ren) to remain safely and home, to being laid aside, you and each of you attend __________________________________________________________________________________________________ Honorable at the Court __________________________________________________________________________________________________ , the located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed ( reasonable to testify and give evidence as and reunify the family prior to the part of the or) adjourned date, efforts by the Department to preservea witness in this action on the placement of the child(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the child(ren)'s home and to make it possible for said child(ren) to remain safely in the home were not required pursuant to O.C.G.A. Section 15-11-58 (a)(4) (A-C) because: ___________________________________________________________________________________________ Your failure to comply reasonable efforts to preserve and reunify the family prior to court and will make you ( ) the Department failed to make with this subpoena is punishable as a contempt of the placement of the child(ren) liable to the party on whose to prevent or eliminate the was for removal of the child(ren) penalty child(ren)'s home and to make sustained as a in foster care, behalf this subpoena need issued for a maximum from the of $50 and all damages it result ofpossible for saidto comply. remain safely in the home. The following efforts would have been reasonable to prevent or your failure child(ren) to eliminate the need for removal: _________________________________________________________________________ Witness, Honorable , one of the Justices of the IT IS THEREFORE ORDERED that said child(ren) be placed in the custody of _____________________________________ until further Order of the Court or until released by a person duly authorized by the Court. Said child(ren) is/are being placed pursuant to Court in County, day of , 20 Official Code of Georgia Ann. Section 15-11-46 for the following reasons: ( ) to protect the person or property of others or of the child(ren); ( ) (Attorney must sign the child(ren) may abscond or be removed from the jurisdiction of the court; above and type name below) ( ) because he/she/they has/have no parent, guardian, or custodian or other person able to provide supervision and care for him/her/them and return him/her/them to the Court when required; ( ) an Order for his/her/their detention or shelter care has been made by the Court pursuant to the Juvenile Proceedings Code. Attorney(s) for Pursuant to O.C.G.A. Section 15-11-48(f), the Court approves the following physical placement of the child(ren):________________ ________________________________ pending the 72 Hour Hearing on __________________________ at ____________, ____.m. Office and P.O. Address It is further ordered that the custodian be and hereby is authorized to obtain a physical examination, ordinary medical care, and such additional medical treatment and care which, in the opinion of a licensed physician, requires prompt treatment for the care of said child(ren) while said child(ren) is/are in his/her/its custody. Telephone No.: Facsimile No.: ORDERED AND ADJUDGED this _______ day of __________________________, 20____. E-Mail Address: Mobile Tel. No.: JUDGE ______________ County Juvenile Court American LegalNet, Inc. www.USCourtForms.com