Petition for At-Risk Youth (PTARY) - Page 1 of 3 WPF JU 05.0600 (07/2017) - RCW 13.32A.191 Superior Court of Washington County of Juvenile Court In the Interest of: D.O.B.: NO: Petition for At-Risk Youth (PTARY) I. Basis I represent to the court the following: 1.1 Identification of the petitioners: Name 1 2 Date of Birth Driver222s License or Identicard (# and State ) Home Address 1.2 Child alleged to be a youth-at-risk. Name Date of Birth Sex Home Address FOR OFFICIAL USE ONLY Juv. Ref. No.: American LegalNet, Inc. www.FormsWorkFlow.com Petition for At-Risk Youth (PTARY) - Page 2 of 3 WPF JU 05.0600 (07/2017) - RCW 13.32A.191 1.3 Indian status: The petitioner knows or has reason to know that an Indian child is involved. Does not apply. 1.4 Each petitioner is a parent of the child. 1.5 Each petitioner has legal custody of the child. 1.6 The child is not the subject of a dependency proceeding under Chapter 13.34 RCW. 1.7 The child is an at-risk-youth because he/she: Has been absent from home for more than seventy-two (72) consecutive hours without parental consent; Is beyond parental control such that the child222s behavior endangers the health, safety and welfare of the child or another person; Has a substance abuse problem and there are no pending criminal charges related to the substance abuse. 1.8 Court intervention and supervision are necessary to assist the petitioner(s) to maintain the care, custody, and control of the child. 1.9 Alternatives to court intervention have been attempted. There is good cause why alternatives to court intervention have not been attempted. 1.10 The above allegations are based on the following facts: American LegalNet, Inc. www.FormsWorkFlow.com Petition for At-Risk Youth (PTARY) - Page 3 of 3 WPF JU 05.0600 (07/2017) - RCW 13.32A.191 II. Relief Requested (Joint petitions must be signed by both petitioners.) I/We request that the court inquire into this matter and provide the relief available under Chapter 13.32A RCW. Dated: Petitioner Petitioner III. Certification I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Mother Date/Place of Signature Father Date/Place of Signature American LegalNet, Inc. www.FormsWorkFlow.com