FAMILY DRUG COURT AGREEMENT AND WAIVER In support of admission to the Washoe County Family Drug Court Program, the below named Participant agrees to the terms, conditions and waivers listed below upon being accepted by the Court for participation in this program. Participant:_______________________________________________ Address:__________________________________________________ __________________________________________________________ Telephone:_________________________ Date of Birth:______________ CUSTODY PETITION PROCEEDINGS AND WAIVER 1. I understand that I have the right to hire an attorney to represent me at every stage of my child protective services case. I understand th at if the Washoe County Department of Social Services (Department) files a formal Petition for Custody, and if I am indigent, I can file a motion f or appointment of a Public Defender to represent me at the petition hearing and all further court hearings. I understand that if I do not file the motion, the Court will proceed with the hearing, and I shall represent myself. I understand that even if I do not file the motion for appointm ent of counsel at the petition hearing, I can still file a motion for appoin tment of counsel at a later stage in the proceedings. 2. I understand and agree that my participation in the Family Drug Court is voluntary. I understand that I have a right to disagree with a ny of the terms and conditions contained in this agreement. However, I understand that my acceptance into the Family Drug Court is conditioned on my acceptance of all terms and conditions of this agreement. 3. After the emergency protective custody hearing, if a formal Petition for Custody of my child/children/ward(s) is filed by the Department in the District Court, and the Court and the Department determine that I meet >>>> 2 the eligibility for Family Drug Court, I hereby agree to give up my righ t to an Evidentiary Hearing on the Petition and proceed on the allegations contained in the Petition for Custody. I further agree to either submit or admit to the allegations in the Petition for Custody with the understanding that the Court will enter the findings of neglect and/or abuse and that my child/children/ward(s) is/are in need of protection within the definitions contained in Nevada Revised Statute Chapter 432B. 4. Under the Nevada Revised Statutes Chapter 432B, a child is in need of protection if: (a) He has been abandoned by a person responsible for his welfare; (b) He is suffering from congenital drug addiction or the fetal alcohol system because of the faults or habits of a person responsible for his welfare; (c) He has been subjected to neglect or abuse by a person responsible for his welfare; (d) He is in the care of a person responsible for his welfare and another child has died as a result of the abuse or neglect by that person; or (e) He has been placed for care or adoption in violation of law. A child may be in need of protection if the person responsible for his welfare: (a) Is unable to discharge his responsibilities to and for the child because of incarceration, hospitalization, or other physical or mental incapacity; (b) Fails, although he is financially able to do so or has been offered financial or other means to do so, to provide for the following needs of the child: >>>> 3 (1) Food, clothing or shelter necessary for the childs health or safety; (2) Education as required by law; or (3) Adequate medical care; or (c) Has been responsible for the abuse or neglect of a child who has resided with that person. 5. I understand that at every review hearing, I have the right to cross-examine witnesses produced by the Department or Division of Child and Family Services (DCFS). I further understand that I have the righ t to contest the evidence submitted by the Department and/or treatment providers and present evidence of my own. TREATMENT PROGRAM 1. I agree to satisfactorily complete a diagnostic evaluation for my drug treatment program through the Department or any other provider acceptable to the Court. 2. I understand that the Washoe County Family Drug Court Program involves the participation of myself, the Court, and the Family Drug Cou rt Team. I further understand that the Family Drug Court Team consists of: Court staff; the Washoe County Department of Social Services; the State of Nevada Division of Child and Family Services; Choices Unlimited; Step II; NASAC; the Department of Parole and Probation; District Attorney s Office; Attorney Generals Office; Public Defenders Office; private defense counsel if applicable; CASA; Integrated Services; and the Foster Grandparent Program. 3. I hereby authorize the release of all information, either in written reports or verbal testimony, regarding my treatment, child protective services case, criminal case and probation to all member of the Family Drug Court Team for the limited purposes of determining my progress in meeting the Family Drug Court monitoring criteria for treatment and reunification for the term of my participation in the program. I author ize the Court and the Family Drug Court team to staff my case prior to my court appearances. My authorization to release treatment information including urinalysis test results is accompanied with the understanding >>>> 4 that such information shall not be utilized by the District Attorney for any prosecution of criminal charges against me. I further understand and agree, however, that such information may be considered by the Court in determining whether I should remain in the program. I further understand that any Family Drug Court Team member may re-disclose my treatment information pursuant to Federal regulations only in connection with their official duties. 4. I also hereby authorize the release of any information regarding my child protective services case pertaining to any school records, medical records, counseling records, psychological and psychiatric records to the Family Drug Court Team for the limited purposes of determining my progress in meeting the Family Drug Court monitoring criteria for reunification for the term of my participation in the program. 5. I understand and agree that I may revoke my consent for disclosure of confidential treatment information at anytime. However, I further understand that such revocation would not allow my further participation in the Family Drug Court Program. I