IN THE STATE OF MARYLAND ____________________________________, MARYLAND CITY or COUNTY In the Matter of: ________________________________ RESPONDENT'S FULL NAME ________________________________________________ RESPONDENT’S DOB Sitting as a Juvenile Court ) ) ) ) ) Case Number: ______________________ ) ) ) SHELTER CARE ORDER Upon consideration of the CINA Petition submitted by the_________________________, and with the [PARTY] following persons present: Child Child’s Attorney Case/Social Worker DSS Attorney Mother Advised of right to counsel Self Represented Father Advised of right to counsel Self Represented Guardian Advised of right to counsel Self Represented Custodian CASA Other_________________ Mother’s Attorney Father’s Attorney Guardian’s Attorney Other________________ and having heard this matter on the issue________________, by the Court for_____________________, on this [CITY or COUNTY] ____ day of ____________, 20_____, [MONTH] THE COURT FINDS: The _____________ attorney amended the Petition in the following manner: ________________________ [DSS or COUNTY ] _______________________________________________________________________________________________________________________________________ At the time of removal, the child/respondent was in the physical custody of __________________________, [INDIVIDUAL NAME] _____________________________________, with whom the child began living on _________________and [RELATIONSHIP TO THE CHILD] [DATE] in the legal custody of______________________________, _____________________________, with [INDIVIDUAL NAME] [RELATIONSHIP TO THE CHILD] whom the child last lived on _________________. [DATE] Or Information not available because _______________________________. [e.g. abandonment, runaway, etc.] That the evidence presented sustained the finding that continuation of the aforesaid child in the child’s home CC-JO20 (Revised 12/2009) 1 American LegalNet, Inc. www.FormsWorkFlow.com ____ contrary to the child’s welfare and that it ____ possible to return the child to that home [is or is not] [is or is not] because the following circumstances exist: ________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________; It is further found that the evidence presented sustained that reasonable efforts to prevent or eliminate the need for removal of the child: were made because of the following ________________________________________________ ____________________________________________________________________________________ _________________________________________________________________________________; or were not made because the following emergent circumstances existed _____________________ ____________________________________________________________________________________ _________________________________________________________________________________; or were not made. The efforts or absence of reasonable efforts were not reasonable for the following reasons _____________________________________________________________________ __________________________________________________________________________________________ _______________________________________________________________________________________; or That the Court has not determined whether reasonable efforts were made or whether there was an emergent situation, but will do so as a result of evidence presented at the Adjudication Hearing and so certify in the subsequent Order of the Court. The local department is not required to provide reunification services because this case involves a case of abuse, torture, or crimes of violence in accordance with Courts and Judicial Proceedings Article of the Annotated Code of Maryland §3-812 as indicated by the following: ___________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ In light of the above findings on this ____ day of ____________, 20_____, it is therefore ORDERED, [MONTH] ORDERED, that Shelter Care is DENIED; or ORDERED, that Shelter Care ________________ pending an Adjudication Hearing; [GRANTED or DENIED] ORDERED, that the Respondent, ________________________, _________________ placed [NAME OF RESPONDENT ] REMAIN or BE in the custody of the ______________________________________; or [NAME OF PARENT(S)/RELATIVE/OTHER] in the custody of the __________________________ pending further disposition before [LOCAL DSS] this Court on the above-captioned matter. By parties’ consent, the child shall be placed with ___________________ pending [INDIVIDUAL NAME] further court order subject to the following conditions: CC-JO20 (Revised 12/2009) 2 American LegalNet, Inc. www.FormsWorkFlow.com and it is further, ORDERED, that _________________of the _________ his/her agents, assigns and successors is [EXECUTIVE DIRECTOR] [LOCAL DSS] granted a 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. It is further, ORDERED, that visitation between _______________________________________ and [RESPONDENT (S) OR FIRST OR FULL NAME OF CHILD] _______________________________________ be: ___________________________________ ______________________________________________________________________________ Describe the visitation arrangements for parents, siblings and others. [e.g, there is a 3 month abstinence from all drug/alcohol abuse] ORDERED, [Description of any additional Orders of the Court] to; Parent Local DSS Guardian Other _________________________________________________________________. _________________________________________________________________. _________________________________________________________________. _________________________________________________________________. ORDERED, THAT ALL PARTIES ARE TO RETURN TO THIS COURT FOR THE _______________ HEARING TYPE HEARING ON THE _______DAY OF________________, 20_____ AT ____A.M./P.M THAT ALL PARTIES PRESENT HAVE A CONTINUING OBLIGATION TO ASSIST THE COURT IN INDENTIFYING AND LOCATING EACH PARENT OF EACH CHILD. THAT ALL PARENTS PRESENT SHALL CONTINUALLY KEEP THE CLERK OF THE COURT AND THE DEPARTMENT OF SOCIAL SERVICES APPRISED OF THEIR CURRENT ADDRESS. ALL PARTIES LISTED ABOVE A 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 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 CC-JO20 (Revised 12/2009) 3 American LegalNet, Inc. www.FormsWorkFlow.com