SUPERIOR COURT Unit In Re: Child's Name STATE OF VERMONT FAMILY DIVISION Docket No. DOB: Child's REQUEST TO ATTEND CONFIDENTIAL JUVENILE HEARING I, ____________________________wish to attend a hearing on _________________ at _____________. Date Time I understand that juvenile hearings are confidential. I understand that if I am given permission to attend a hearing, I will not be a party to the case. I have no right to appeal any decisions. The hearing will proceed in my absence if I am not there. The reason for my request is: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Please note: Vermont law says there shall be no publicity given by any person to any juvenile proceedings except with the consent of the child, the child's guardian ad litem, and the child's parent, guardian, or custodian. A person who violates this provision may be subject to contempt proceedings. 33 V.S.A. § 5110 (c) My mailing address is: Name Street Address Apt. or P.O. Box Number City Phone Numbers Day time: Email: State Zip Evening: Dated _____________________________ ___________________________________ Signature 400-00127­ Request to Attend Confidential Juvenile Hearing (10/2015) American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1