COUNTY[IES] DIVISION TRIAL COURT OF MASSACHUSETTS JUVENILE COURT DEPARTMENTDOCKET NO. PETITION FOR GRANDPARENT VISITATION1. I/we,request visitation with .(name(s))(child(ren)'s name(s))2. I/we am/are the child(ren)'s:Signed under the pains and penalties of perjury. ORDERAfter a determination of what is in the best interest of the child(ren) by considering the goal of the service plan andthe relationship between the grandparent(s) and the child(ren)'s parent(s) or legal guardian(s), the within petition ishereby: ALLOWED DENIED(Petitioner's Signature/ Grandparent No. 1)(Date)(Date)(Justice), who reside at(street and no.)(city or town)(state)(zip code)3. The child(ren) is/are currently the subject of the following case(s) in this court: Care and Protection Children in Need of Services4. The child(ren) is/are currently in the custody of: Department of Children and Families5. I have have not requested visitation from the custodian.WHEREFORE, I request that the court grant me/us visitation with my/our grandchild(ren). (Petitioner's Signature/ Grandparent No. 2)(Attorney's Signature (if applicable))(Date) FOR COURT USE ONLY(Telephone No.)(BBO No.)JV-53 (07/20/2010),.. maternal grandparent(s). The child(ren)'s mother's name is: paternal grandparent(s). The child(ren)'s father's name is: Other: American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR FILING A PETITION FOR GRANDPARENT VISITATIONA Petition for Grandparent Visitation must be filed in the court where there is an underlyingcare and protection and/or CHINS case for the child(ren) you wish to visit.COMPLETING PETITION: Type or print the petition.No. 1: Fill in your name and address. You are the petitioner.Nos. 2-5: Check off and fill in all that apply.After you have completed the petition, return it to the Clerk-Magistrate's office of the courtwhere you are filing your case. You may mail or bring the completed petition to the Clerk-Magistrate's office.NOTICE REQUIREMENTS:Once the Clerk-Magistrate receives the completed form, the court will set a date for you andthe parties to appear in court for a hearing. The Clerk-Magistrate's office will mail to you or ifyou file the petition in person, hand to you an Order of Notice of the hearing date along with acopy of your petition. You must mail or hand deliver to each party on the case the following: 1) Copy of the Petition for Grandparent Visitation 2) Order of NoticeIf you mail a copy of the petition and Order of Notice to the party, you must mail it no later thanten (10) days prior to the hearing.If you hand deliver a copy of the petition and Order of Notice to the party, you must deliver it tothe person no later than seven (7) days prior to the hearing.Do I need an attorney? You are not required to bring an attorney to the hearing, but you maydo so if you wish. By law, the court cannot appoint an attorney for you even if you cannotafford one.What happens if you cannot come to court on the date of the hearing? All parties mustcome to court on the date the case is scheduled for hearing. If you cannot come to court onthat date, contact the clerk's office immediately upon receipt of your court date.JV-53 (07/20/2010) American LegalNet, Inc. www.FormsWorkFlow.com