COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .__________________ COUNTY JUVENILE COURT ......... .. FILED IN THE CLERK'S OFFICE ON THE________ :DAY OF __________________________, 20______ . Index No. ____________________________________________ CLERK/DEPUTY CLERK : Calendar No. ORDER FOR SHELTER CARE : JUDICIAL SUBPOENA Plaintiff(s) -against-IN THE JUVENILE COURT OF : ________________________ COUNTY, GEORGIA In the interest of _________________________________________ A Child : SEX________________ DOB_________________ FILE #______________ CASE #______________ : A complaint has been made to the Court concerning the above-named child. The Court finds from information Defendant(s) : . .brought.before.it . . . .continuation. in.the .home. at.this.time .would .be .contrary to the welfare of said child. It is . . . . . . . . . . that . . . . . . . . . . . . . . . . . . . . . . . . . . . necessary for the protection of said child that that he/she be placed in shelter care because ___________________ ____________________________________________________________________________________________ The Court also finds that pursuant to O.C.G.A. §15-11-58(a): THE PEOPLE OF THE STATE OF NEW YORK ( ) TO reasonable efforts have been made by the Department to preserve and reunify the family prior to the placement of the child in foster care, to prevent or eliminate the need for removal of the child from the child's home and to make it possible for said child to remain safely in the home, to wit:_____________ ___________________________________________________________________________________ ___________________________________________________________________________________ GREETINGS: ( ) reasonable efforts by the Department to preserve and reunify the family prior to the placement of the child in foster care, to prevent or eliminate the need for removal of the child from the child's home and to make it possible YOU, that to business and excuses being laid required pursuant to O.C.G.A. WE COMMANDfor said childall remain safely in the home were not aside, you and each of you attend before §15-11-58 (a)(4) (A-C) because:________________________________________________ , the Honorable at the Court located at County of ___________________________________________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed ( ) the Department failed to make reasonable efforts to preserve and reunify the family prior to the or adjourned date, to testifychild give evidence as a witness in this action on the part ofof the child from the and in foster care, to prevent or eliminate the need for removal the placement of the child's home and to make it possible for said child to remain safely in the home. The following efforts would have been reasonable to prevent or eliminate the need for removal: ________________________ ___________________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to IT IS THEREFORE ORDERED that said child issued in a maximum _______________________________ the party on whose behalf this subpoena wasbe placedfor the custody of:penalty of $50 and all damages sustained as a until further failure to Court or result of yourorder of thecomply. until released by a person duly authorized by the Court. Said child is being placed pursuant to O.C.G.A. §15-11-46 for the following reasons: ( ) Witness, Honorable or property of others or of the child; to protect the person , one of the Justices of the ) Court (in the child may abscond or be removed from the jurisdiction of the Court; County, day of , 20 ( ) because the child has no parent, guardian, or custodian or other person able to provide supervision and care for him or her and return him or her to the Court when required; or ( ) (Attorney must sign pursuant to the Juvenile an order for the child's detention or shelter care has been made by the Courtabove and type name below) Proceedings Code. Pursuant to O.C.G.A. §15-11-48(f), the Court approves the following physical placement of the child: __________ ____________________________ pending the 72 Hour Hearing on Attorney(s) for ______________________ at ______, ___.m. 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 the said child while said child is in his/her/its custody. Office and P.O. Address ORDERED AND ADJUDGED this __________ day of ____________________________, 20________. ___________________________________________ Judge/Associate Judge of Telephone No.: _______________________ County Juvenile Court Facsimile No.: Rev. 05/2001 E-Mail Address: Mobile Tel. No.: JUV-19 American LegalNet, Inc. www.USCourtForms.com