IN THE CIRCUIT COURT FOR _____________________COUNTY, MARYLAND Sitting as a Juvenile Court In The Matter of: * _______________________ * Respondent(s) Case Number(s): DOB(s): * ADJUDICATION HEARING ORDER PENDING DISPOSITION Upon consideration of the _____________________ presented at an adjudication hearing, and with the following persons present: Child _________________ Case Worker ____________ Mother _________________ Father __________________ Guardian _______________ CASA _________________ Child’s Attorney _______________ DSS Attorney _________________ Mother’s Attorney ______________ Father’s Attorney_______________ Custodian _____________________ Other ________________________ the Court for __________ (county), on this ________day of ______________ , 200___ , finds in accordance with Rule 11-114 and the Courts and Judicial Proceedings Article of the Annotated Code of Maryland §3-817, that the allegations in the CINA petition have been proven by a preponderance of the evidence, and that the following facts as alleged in the petition were sustained: a.____________________________________ b.____________________________________ c.____________________________________ d.____________________________________ e.____________________________________ The following counts in the petition were not sustained: a.____________________________________ b.____________________________________ c.____________________________________ The following additional facts were found: That the evidence presented sustained the finding that continuation of the aforesaid child in the child’s home Page 1 of 6 JO 21 – Revised 1 February 2006 American LegalNet, Inc. www.FormsWorkflow.com is not contrary to the child’s welfare and that it is now possible to return the child to that home because the following circumstances exist: or is contrary to the child’s welfare and that it is not possible to return the child to that home because the following circumstances exist: (If the Court did not address reasonable efforts to prevent or eliminate the need for removal of the child at the shelter care hearing, the following language should be used.) That the evidence presented sustained the finding that the following reasonable efforts were made prior to placement to prevent or eliminate the need for removal of the child: or That the evidence presented sustained the finding that because of the emergent nature of the situation, such reasonable efforts to prevent or eliminate the need for removal of the child could not be made; the emergent nature that existed is that: or Page 2 of 6 JO 21 – Revised 1 February 2006 American LegalNet, Inc. www.FormsWorkflow.com That the absence of efforts to prevent removal from the home was not reasonable for the following reasons: That having found in accordance with the Courts and Judicial Proceedings Article of the Annotated Code of Maryland §3-819 that good cause does exist to delay the disposition hearing to a subsequent date, delays the disposition hearing for the following reasons: IN ADDITION, IF APPLICABLE That the local department is not required to provide reunification services because one of the following circumstances exist:  The child has been in an out-of-home placement for 15 of the most recent 22 months; or  The child is an abandoned infant; or  The parent has been convicted:  in this state of a crime of violence, as defined in § 14-101 of the Criminal Law Article, against (check all applicable) _______ the Respondent (s), _______the other parent of the Respondent (s), _______another child of the parent, or _________ any individual who resides in the household of the parent. __________________________ was convicted of ____________________ on the _______ of _________________, 20___, in the Circuit Court for _________________ (County/City), _________________ (Case Number); or Page 3 of 6 JO 21 – Revised 1 February 2006 American LegalNet, Inc. www.FormsWorkflow.com  in any state or in any court of the United States of a crime that would be a crime of violence, as defined in the Criminal Law Article of the Annotated Code of Maryland § 14-101, if committed in this state against (check all applicable) ________ the Respondent (s) _______ the other parent of the Respondent (s), _______ another child of the parent, or _______ any individual who resides in the household of the parent. _________________________ was convicted of ____________________ in the State of ________________ on the ________ of _______________, 20___ in the Court for _______________________ (County/City), Case Number ____________; or  of aiding or abetting, conspiring, or soliciting to commit the crime of ______________________ on the ________ of _______________, 20___ in the Court for _______________________ (County/City), Case Number ____________. The Court further finds that although one of the above reasons for filing a petition to terminate parental rights exist, it is not in the best interest of the child for DSS to file a petition to terminate parental rights because:  the child is being cared for by a relative; or  the local department has not provided necessary and/or appropriate services to help reunify and safely return the child to its home; or  the local department has documented the following compelling reason why termination of parental rights would not be in the child’s best interests: In light of the above-stated factual findings, on this __________day of ______________200_____, it is therefore: ORDERED, that ____________________________________ (Respondent (s) or Child’s First or Full name) be placed temporarily in the custody of __________________ ORDERED, that ______________________________ (Respondent (s) or Child’s First or Full Name) be placed temporarily in the custody of ________________________ for further shelter care placement pending further disposition before this Court on the Page 4 of 6 JO 21 – Revised 1 February 2006 American LegalNet, Inc. www.FormsWorkflow.com above-captioned matter; and it is further, ORDERED, that ________________________ (Name of the Executive Director) of ________________ DSS, his/her agents, assigns and successors is granted a temporary limited guardianship for medical, educational and out of state travel purposes, only, to consent to the provision of routine medical, including mental health and dental care and educational services to the child. ORDERED, that visitation between _____________________ (Respondent (s) or Child’s First or Full Name) and __________________________be: liberal and unsupervised; or liberal and supervised as arranged by the department of social services with a minimum of ______________ (specify frequency); or until ______________________________________ (e.g., there is a 3-month period of abstinence from all drug/alcohol abuse); or as arranged between the parties; ORDERED, that there be no contact between the _______________________ (Respondent (s) or Child’s First or Full Name) and ___________________________. ORDERED, that visitation between ___________________ (the Respondent(s) or Child’s First or Full Name) and sibling(s) shall be liberal with a minimum of __________________ (specify frequency) as arranged by DSS or as arranged by the parties, if the child is in the care and custody of one of the parents. ORDERED, that a Writ of Attachment be issued for _____________________for failing to appear for a hearing/AWOL from placement. Upon being apprehended, he/she is to be turned over to a ______________ case worker for temporary shelter care and is to be brought before the Court on the next day the Court sits. ORDERED, that the Writ of Attachment issued against ___________________on the ______ day of _________, 200____ is to be quashed and recalled. ORDERED, that a disposition hearing be scheduled on the _______day of ______________200___, at ________a.m./p.m. before the Court. It is further, ORDERED THAT ALL PARTIES PRESENT HAVE A CONTINUING OBLIGATION TO ASSIST THE COURT IN IDENTIFYING AND LOCATING EACH PARENT OF EACH CHILD; AND Page 5 of 6 JO 21 – Revised 1 February 2006 American LegalNet, Inc. www.FormsWorkflow.com THAT ALL PARENTS PRESENT SHALL CONTINUALLY KEEP THE CLERK OF THE COURT AND THE DEPARTMENT OF SOCIAL SERVICES APPRISED OF THEIR CURRENT ADDRESS. THAT THE PERMANENCY PLAN OF REUNIFICATION MAY BE CHANGED TO ANOTHER PERMANENCY PLAN, WHICH MAY INCLUDE THE FILING OF A PETITION FOR TERMINATION OF PARENTAL RIGHTS IF THE PARENTS HAVE NOT MADE SIGNIFICANT PROGRESS TO REMEDY THE CIRCUMSTANCES THAT CAUSED THE NEED FOR REMOVAL AS SPECIFIED IN THIS COURT ORDER AND ARE UNWILLING OR UNABLE TO GIVE THE CHILD PROPER CARE AND ATTENTION WITHIN A REASONABLE PERIOD OF TIME. EXCEPTIONS SHALL BE IN WRITING AND SHALL BE FILED WITH THE CLERK’S OFFICE. IF ANY PARTY TAKES EXCEPTION, THEY MUST FILE ON OR BEFORE __________________, 200____. THE FILING SHALL SPECIFY THOSE ITEMS TO WHICH EXCEPTIONS ARE TAKEN. COPIES OF EXCEPTIONS MUST BE SERVED ON ALL OTHER PARTIES INVOLVED IN THE CASE. ALL PARTIES LISTED ABOVE AS PRESENT RECEIVED NOTICE OF THE FINDINGS ON THE RECORD AND UPON COMPLETION A COPY OF THIS ORDER WAS HANDED TO THEM SENT BY FIRST CLASS MAIL. A COPY OF THIS ORDER WILL BE MAILED TO THOSE PARTIES NOT PRESENT. SERVICE IS TO BE BY: First class mail Sheriff’s Service on . . Certified Mail, Return Receipt Requested on Appropriate means when an address is supplied to the Court Recommended by: ______________________________ Master ______________________________ Date ______________________________ JUDGE ______________________________ Date Page 6 of 6 JO 21 – Revised 1 February 2006 American LegalNet, Inc. www.FormsWorkflow.com