STATE OF WASHINGTON KING COUNTY DISTRICT COURT NO. ____________________________________ Petitioner vs. Respondent PETITION FOR AN ORDER FOR PROTECTION RESPONDENT UNDER AGE 18 HARASSMENT (PTAH18) 1. I am the parent or guardian of child(ren) under age 18 and petition the court for an Order for Protection against Unlawful Harassment to restrain the respondent, ______ years of age, from contact with my child(ren). 2. 3. I request the court to appoint an appropriate guardian ad litem for the respondent. Respondent has been adjudicated of the following offense against my child(ren): Offense: _________________________________________________________________________ Case Name: ______________________________ Case Number: __________________________ Court/County: ____________________________________________________________________ Respondent is under investigation or has been investigated for the following alleged offense against my child(ren): Alleged offense:____________________________________________________________________ Investigating agency: ________________________________________________________________ 4. The harassment took place in ______________________________ County in ______________________________ County. Respondent lives 5. Identification of Minors (Children under age 18) to be Protected: Name (First, Middle Initial, Last) Age Race Sex How Related to Petitioner Respondent Resides with PT FOR ORD FOR PROT - RESP UNDER 18- (HARASSMENT) (PTAH18) – Page 1 of 3 UH-05.0100 (6/2002) - RCW 10.14.040, (Ch. 117 L 2002 § 2) American LegalNet, Inc. www.FormsWorkFlow.com 6. Other court cases or any other protection, restraining or no-contact orders involving the petitioner, the minors to be protected and the respondent: CASE NAME AND NUMBER COURT/COUNTY REQUEST FOR TEMPORARY ORDER: AN EMERGENCY EXISTS as described in the statement below. I need a temporary restraining order issued immediately without notice to the respondent until a hearing to avoid great or irreparable harm. I request a Temporary Order for Protection that will: I REQUEST AN ORDER FOR PROTECTION following a hearing THAT WILL: RESTRAIN respondent from making any attempts to keep under surveillance the minors named in paragraph 5 above. RESTRAIN respondent from making any attempts to contact the minors named in paragraph 5 above. RESTRAIN respondent from entering or being within __________________(distance) of the residence work place of the minors named in paragraph 5 above. other: RESTRAIN respondent from attending _________________________________ school at ____________________________________________________________ (address) attended by the minors named in paragraph 5 above and ORDER respondent to transfer to a different school. OTHER: REMAIN EFFECTIVE longer than one year because respondent is likely to resume acts of unlawful harassment against the minors named in paragraph 5 above if the order expires in a year. Unlawful harassment means a knowing and willful course of conduct directed at a specific person which seriously alarms, annoys, or harasses, or is detrimental to such person and which serves no legitimate or lawful purpose. The course of conduct shall be such as would cause a reasonable person to suffer substantial emotional distress and shall actually cause substantial emotional distress to the petitioner or when the course of conduct would cause a reasonable parent to fear for the well-being of their child. Course of conduct means a pattern of conduct composed of a series of acts over a period of time, however short, evidencing a continuity of purpose. “Course of conduct” includes, in addition to any other form of communication, contact, or conduct, the sending of an electronic communication. Constitutionally protected activities are not included within the meaning of “course of conduct.” STATEMENT: The respondent has committed acts of unlawful harassment as follows: (Describe specific acts of harassment and their approximate dates, beginning with the most recent act. Describe the PT FOR ORD FOR PROT - RESP UNDER 18- (HARASSMENT) (PTAH18) – Page 2 of 3 UH-05.0100 (6/2002) - RCW 10.14.040, (Ch. 117 L 2002 § 2) American LegalNet, Inc. www.FormsWorkFlow.com adjudicated offense or the alleged offense listed in paragraph 2 above. Include information regarding the severity of the alleged offense and any continuing physical danger or emotional distress to the minors. You may want to include police responses.) If you requested a fee waiver, describe the incident(s) involving stalking, a sex offense, or domestic violence: (Continue on separate page if necessary) I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. DATED at Washington. ___________________________________ Petitioner You have a right to keep your residential address confidential. You may list an address that is not your residential address where you agree to accept legal documents: PT FOR ORD FOR PROT - RESP UNDER 18- (HARASSMENT) (PTAH18) – Page 3 of 3 UH-05.0100 (6/2002) - RCW 10.14.040, (Ch. 117 L 2002 § 2) American LegalNet, Inc. www.FormsWorkFlow.com