Superior Court of Washington County of _______________________ Juvenile Court No: Dependency of: SHELTER CARE HEARING ORDER Agreed Contested Default (SCOR) D.O.B.: Clerk’s Action Required. Paragraphs 3.15, 3.16., 3.17 Restraining Order Summary: [ ] Does not apply. [ ] Restraining Order Summary is set forth below: Name of person(s) restrained: person(s) protected: . Name of See paragraph 3.15. I. Hearing 1.1 A dependency petition was filed in this matter by DSHS Licensed Child Placement Agency ____________________________ Other __________________________ and a hearing was held on ___________________________________ [Date]. 1.2 Persons appearing at the hearing were: Child Mother Father Guardian or Legal Custodian Child's GAL DSHS/Supervising Agency Worker Tribal Representative Other ___________________________ 1.3 Child's Lawyer Mother's Lawyer Father's Lawyer Guardian's or Legal Custodian's Lawyer GAL's Lawyer Agency’s Lawyer Current Caregiver Testimony was taken. SHELTER CARE HEARING ORDER (SCOR) - Page 1 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com II. Findings The Court Finds: 2.1 The notice required under RCW 13.34.062 was given to the mother father child age 12 or older guardian legal custodian other:________________. Reasonable efforts to provide notice to the mother father child guardian legal custodian other:_____________________ and to inform them of their rights have have not been made by petitioner. 2.2 Indian status: The child is an Indian child as defined in 25 U.S.C. 1903(4). The Indian Child Welfare Act does apply to these proceedings. The petitioner has has not made preliminary efforts to notify the child’s tribe of these proceedings. All notice requirements and evidentiary requirements under the Indian Child Welfare Act have not yet been satisfied. The child is not an Indian child as defined in 25 U.S.C. 1903(4), and the Indian Child Welfare Act does not apply to these proceedings. It has not been determined whether the child is an Indian child as defined in 25 U.S.C. 1903(4). 2.3 The parties present at the hearing were informed of their rights pursuant to RCW 13.34.065 and 13.34.090. 2.4 2.5 The mother father guardian legal custodian requests a waiver of the shelter care hearing. The court determines that the waiver is knowing and voluntary. Shelter Care Factors: The court has considered the following factors: (a) What services DSHS/Supervising Agency provided to the family to prevent or eliminate the need for removal of the child from the child’s home. (b) Whether the child can be safely returned to the home pending the dependency factfinding hearing (c) Whether restraining orders or orders excluding an allegedly abusive person from the house will allow the child to safely remain in the home. (d) What efforts DSHS/Supervising Agency made to place the child with a relative known to the child and with whom the child has a relationship. (e) Whether the placement proposed by DSHS/Supervising Agency is the least disruptive and most family-like setting that meets the needs of the child. (f) Appointment of an attorney or guardian ad litem for the child’s parent, guardian, or legal custodian, or for the child. (g) Whether it is in the best interest of the child to remain enrolled in the school, developmental program, or child care the child was in prior to placement and what efforts have been made to maintain the child in the school, program, or child care if it would be in the best interest of the child to remain in the same school, program, or child care. (h) The terms and conditions for parental, sibling, and family visits. SHELTER CARE HEARING ORDER (SCOR) - Page 2 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com 2.6 Reasonable efforts were made by petitioner to prevent or eliminate the need for removal of the child from the child’s home. For the reasons set forth in the dependency petition, supporting declarations and affidavits, and/or the testimony presented to the court: The risk of imminent harm to the child as assessed by petitioner establishes reasonable cause for the continued out-of-home placement of the child pending the fact finding hearing; Specific services offered or provided to the parent(s) have been unable to remedy the unsafe conditions in the home and make it possible for the child to return home; Returning the child to the home would seriously endanger the child’s health, safety, and welfare; and/or Other: ______________________________________________________________ ______________________________________________________________________. 2.7 It is currently contrary to the welfare of the child to remain in or return home. The child is in need of shelter care because: The child has no parent, guardian, or legal custodian to provide supervision or care for such child; The release of the child would present a serious threat of substantial harm to the child; The parent, guardian or custodian to whom the child could be released is alleged to have violated RCW 9A.40.060 or 9A.40.070. 2.8 There is not reasonable cause to believe that shelter care is needed. 2.9 A relative or suitable person is is not available or willing to care for the child and to meet any special needs of the child or to facilitate the child’s visitation with siblings. There is reasonable cause to believe that placement of the child with the relative or suitable person would jeopardize the safety or welfare of the child hinder efforts to reunite the parent and child. Additional investigation is needed for DSHS/Supervising Agency to determine the character and suitability of the proposed relative or other suitable person placement. 2.10 There is reasonable cause to believe that an incident of sexual or physical abuse has occurred and that a restraining order is necessary pursuant to RCW 26.44.063(2). 2.11 DSHS/Supervising Agency recommends the following examinations, evaluations, or immediate services are needed for the: mother: _________________________________________________________. The mother does does not agree. father: __________________________________________________________. The father does does not agree. child: ___________________________________________________________. 2.12 Education status: The child is not of school age. The child is presently enrolled in school at _________________________________ (name of school and school district). If the child will not remain enrolled in the child’s present school, the reasons for the transfer to a new school are: SHELTER CARE HEARING ORDER (SCOR) - Page 3 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com The child needs to be enrolled in school before the next hearing date. ___________________________________________________ (name/title of person at DSHS/Supervising Agency) is responsible for timely enrolling the child in school. The person identified on the Student Records Authorization Form as responsible for coordinating student’s educational information is __________________________________ (name/title of person at DSHS/Supervising Agency). 2.13 Other: III. Order It is Ordered: 3.1 The child is released to the child’s parent, guardian or legal custodian: Name(s): ___________________________________________________ Address: ___________________________________________________ ___________________________________________________ Subject to the following conditions: . 3.2 The child is placed in or shall remain in shelter care, in the temporary custody and under the supervision of DSHS/Supervising Agency which shall have the authority to place the child in: Licensed foster care. Relative placement with ___________________________ [Name]. [Name]. Placement with a suitable person: Placement with the relative or suitable person is contingent upon the caregiver’s cooperation with the DSHS/Supervising Agency case plan and compliance with this, and all subsequent court orders related to the care and supervision of the child, including but not limited to parent-child contact, sibling contacts, and any other conditions imposed by the court. Subject to the following conditions: . 3.3 DSHS/Supervising Agency shall continue to make reasonable efforts to locate and investigate an appropriate relative who is available and willing to care for the child, and is authorized to share information with potential relative placement resources as necessary to determine their suitability and willingness as a placement for the child. SHELTER CARE HEARING ORDER (SCOR) - Page 4 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com DSHS/Supervising Agency shall have authority to place the child with an appropriate relative suitable person with prior reasonable notice to the parties, subject to review by the court. 3.4 DSHS/Supervising Agency shall provide visits between the child and parent, guardian, or legal custodian as follows: Per attached visitation schedule. ___________________________________________________________________________ . 3.5 If siblings are not placed together, DSHS/Supervising Agency shall provide sibling visits or contact as follows: ____________________________________________________________________ _____________________________________________________________________________ . 3.6 Attorney and guardian ad litem appointments are as follows: attorney guardian ad litem for ______________________________________ [Name]. attorney guardian ad litem for ______________________________________ [Name]. attorney guardian ad litem for ______________________________________ [Name]. attorney guardian ad litem for ______________________________________ [Name]. 3.7 DSHS/Supervising Agency may authorize evaluations of the child’s physical or emotional condition, routine medical and dental examination and care, and all necessary emergency care. 3.8 DSHS/Supervising Agency shall have the right to access, inspect, and copy all records pertaining to the above-named child, including but not limited to health, medical, mental health and educational records. 3.9 DSHS/Supervising Agency shall continue to investigate the child’s Indian status. 3.10 The mother father guardian/legal custodian child shall participate in the following examinations, evaluations, or immediate services: _____________________________________________________________________ ____________________________________________________________________. The mother father guardian/legal custodian child shall participate in the following examinations, evaluations, or immediate services: _____________________________________________________________________ ____________________________________________________________________. The mother father guardian/legal custodian child shall participate in the following examinations, evaluations, or immediate services: _____________________________________________________________________ ____________________________________________________________________. The mother father guardian/legal custodian child shall participate in the following examinations, evaluations, or immediate services: SHELTER CARE HEARING ORDER (SCOR) - Page 5 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com _____________________________________________________________________ ____________________________________________________________________. 3.11 DSHS/Supervising Agency or its designee shall timely enroll the child in school. DSHS/Supervising Agency or its designee shall provide the child’s school with a certified copy of the Order and Authorization Re Health Care and Education. 3.12 The parents shall cooperate with DSHS/Supervising Agency and provide a current address and phone number to the social worker at all times. Within two weeks of the entry of this order, the parents shall provide additional information necessary for placement and notice purposes including: (a) The names, addresses, and phone number of any relatives who may be placement resources for the child. (b) The names, addresses, phone numbers and other identifying information of any alleged parent(s) of the child. (c) Any known information regarding possible membership in or descent from an Indian tribe. (d) Information necessary to determine financial eligibility for services or foster care. (e) Other: _______________________________________________________________. 3.13 The parents shall sign and maintain current releases of information during the course of these proceedings for exchange of information between all evaluators and service providers, DSHS/Supervising Agency, CASA/GAL, Juvenile Court, AAG, and the parents’ attorneys. 3.14 The alleged father(s) ______________________________________ shall cooperate in the establishment of paternity and shall complete all interviews, paperwork, and genetic testing within _______ days of the entry of this order. The mother shall cooperate in the establishment of paternity and shall complete all interviews, paperwork, and genetic testing within _______ days of the entry of this order. The child shall be made available for genetic testing. NOTICE: Failure of the alleged father(s) to establish parentage may be deemed a waiver of any right to be offered or provided remedial services, visits with the child, or ongoing party status. Such failure may also be used as evidence in a termination of parental rights proceeding. 3.15 __________________________________ (Name) is restrained from: (a) (b) (c) (d) Molesting the child or disturbing the child’s peace. Entering the family home of the child except as specifically authorized by the court. Having any other contact with the child, except as specifically authorized by the court. Knowingly coming within, or knowingly remaining within _______________ (distance) of _________________________________________________________ (location). (e) Other: ____________________________________________________________ __________________________________________________________________ __________________________________________________________________. Violation of This Restraining Order With Actual Notice of its Terms is a Criminal Offense Under Chapter 26.44 RCW and is Also Subject to Contempt Proceedings, and Will Subject a Violator to Arrest. RCW 26.44.063(8) and .067(3). SHELTER CARE HEARING ORDER (SCOR) - Page 6 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com The person having physical custody of the child has an affirmative duty to assist in the enforcement of this restraining order and to notify law enforcement, DSHS/ Supervising Agency, and the court as necessary to request assistance and/or report violations of the order. SHELTER CARE HEARING ORDER (SCOR) - Page 7 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com 3.16 A case conference/__________________________________ shall be held: On: ________________________________ [Date] at ______________ a.m./p.m. At: _____________________________________________________________. Address: __________________________________________________ __________________________________________________ A case conference is not ordered at this time because the parent shelter care did not want to participate. 3.17 did not appear at A __________________________________________ hearing shall be held: On: ____________________________ [Date] at __________________ a.m./p.m. At: ____________________________ Court, Room/Department: _________________ Address: _________________________________________________________ _________________________________________________________ 3.18 3.19 DSHS/Supervising Agency shall make reasonable efforts to advise the child’s mother father legal guardian or custodian of the status of this case, including the date and time of the hearing scheduled above and their rights under RCW 13.34.090. Other: Dated: _______________________________________ JUDGE/COMMISSIONER Presented by: Signature Print Name/Title WSBA No. Copy Received. Approved for entry, notice of presentation waived. Signature of Child Signature of Child’s Lawyer Print Name Signature of Mother Pro Se, Advised of Right to Counsel WSBA No. Signature of Mother’s Lawyer SHELTER CARE HEARING ORDER (SCOR) - Page 8 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com Print Name Signature of Father Pro Se, Advised of Right to Counsel WSBA No. Signature of Father’s Lawyer Print Name Signature of Guardian or Legal Custodian Pro Se, Advised of Right to Counsel WSBA No. Signature of Guardian or Legal Custodian’s Lawyer Print Name WSBA No. Signature of Child’s GAL Signature of Lawyer for the Child’s GAL Print Name Print Name Signature of Agency Representative Signature of Agency Representative’s Lawyer Print Name Print Name Signature of Tribal Representative Signature Print Name Print Name WSBA No. Lawyer for _______________________ WSBA No. WSBA No. SHELTER CARE HEARING ORDER (SCOR) - Page 9 of 9 WPF JU 02.0200 (7/2007) - JuCR 2.1, 2.3, 2.4; RCW 13.34. 062, .065 American LegalNet, Inc. www.FormsWorkflow.com