FCA §1090-a Form PH-4c (6/2016) NOTIFICATION OF CHILD(REN)'S PARTICIPATION AT PERMANENCY HEARING This form shall be submitted to the Court and to the attorneys 10 days prior to the permanency hearing. Title of case:___________________________________________________________________________ Judge, Referee or Court Part Number:_____________________________________________________ Family Unit Number(s):___________________ Permanency Hearing Date:_____________________ Docket Number(s):_____________________________________________________________________ G The following child(ren) will participate in the permanency hearing, in person: ________________________________ ______________________________________ ________________________________ ______________________________________ ________________________________ ______________________________________ G The following child(ren) will participate in the permanency hearing, by other means [specify: by telephone; other electronic means (if available, specify); or written statement]: Name (list child's name) Manner of participation: ___________________________________________ _____________________________ ___________________________________________ _____________________________ ___________________________________________ _____________________________ ___________________________________________ _____________________________ G After consultation with my client(s), the following child(ren) is/are waiving the right to attend the permanency hearing: [list child(ren)]: ______________________________________________________ _____________________________________________________________________________________ G The following child(ren) [specify]: ________________________________would like to participate in the manner noted above, but is/are unavailable on the permanency hearing date for the following reason(s) [specify]: _____________________________________________________________________________ _____________________________________________________________________________________________. [NOTE: Any adjournments must be requested by the Attorney for the Child in Court or in accordance with local court procedures and in all cases must be approved by the Court]. If consultation with child(ren) did not occur, complete this section: G The undersigned attorney for child(ren) consents to the Court conducting the permanency hearing without having consulted with [specify child(ren)]:_____________________________________________for the following reason(s): G the child(ren) lack(s) mental capacity to consult meaningfully with the attorney for the child and cannot understand nature and consequences of hearing as result of a significant cognitive limitation as determined by a health or mental health professional or educational professional as part of a committee on special education and such limitation is documented in the Court record or the permanency hearing report. G the undersigned has made diligent and repeated efforts to consult with child(ren), but the child(ren) was/were unreachable, unresponsive or declined to consult with the attorney for the child [check if applicable]:G and such unavailability is not due to the failure of the foster parent or agency to cooperate in making the child(ren) available. G the child(ren) was/were absent without leave from foster care at time consultation was attempted. G other good cause exists and cannot be alleviated in a timely manner [specify:]______________________ _____________________________________________________________________________________________ __________________________ ______________________ ________________ Signature - Attorney for Child Print Name Date Contact information: Telephone:__________________ E-mail:____________________________ American LegalNet, Inc. www.FormsWorkFlow.com FCA §1090-a TO: Attorneys for the parties, Court Form PH-4c (6/2016) American LegalNet, Inc. www.FormsWorkFlow.com