For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Consent Decree (In-Home Placement Only) Name Case No. Date of Birth The parties stipulate and agree that the court may enter a consent decree, placing the child/juvenile under supervision, consistent with these terms and conditions. 1. The case shall be held open for days/ months. [Chapter 48, up to six months; Chapter 938, up to one year] 2. Placement shall be in the child’s/juvenile’s home. 3. No referrals to intake and/or violations of federal, state or local laws. 4. Restitution $ [Under age 14, $250 limit], payable to Payment terms Make repairs or provide services agreeable to the victim [Under age 14, 40 hour limit] See attached 5. Community service/supervised work program [Under age 14, 40 hour limit] Amount hours. Terms 6. Counseling 7. Other: [Include payment for services under §§48.36, 938.36, 938.361, Wis. Stats.] See attached 8. The court may extend this decree for an additional 6 months [1 year if a youth village placement] upon notice and motion. Unless an objection is made, no hearing will be held. SIGNED BY DATE SIGNED BY DATE Child’s/Juvenile’s Attorney/GAL Child/Juvenile Mother Father Prosecuting Attorney Social Worker Notice: During the period of this consent decree, the child/juvenile may object to its continuation and the hearing under which the child/juvenile was placed on supervision may be continued as if the consent decree had never been entered. THE COURT FINDS: 1. The victim/family has been given an opportunity to make a statement. 2. If restitution/repairs are ordered, the child/juvenile alone is financially able to pay or the custodial parent is financially able to pay. 3. If the child/juvenile is providing services for the victim, the child/juvenile is physically able to perform services for the victim [Under age 14, 40 hour limit] and the victim agrees to accept such services. 4. The consent decree is in the child’s/juvenile’s best interest and is approved. JD-1784, 03/12 Consent Decree (In-Home Placement Only) §§48.32 and 938.32, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Consent Decree (In-Home Placement Only) Page 2 of 2 Case No. THE COURT ORDERS: 1. The parties must comply with all terms and conditions of the consent decree. 2. Failure to comply with this consent decree may result in reinstatement of these proceedings. If not reinstated, the original petition is dismissed at the end of the appropriate period without further order of the court. 3. The appointment of the guardian ad litem for the child/juvenile terminates until further order of the court. is continued to allow the guardian ad litem to perform any of the duties under §48.235(4) or §938.235(4), Wis. Stats. is continued for the following purpose(s): 4. The appointment of the attorney for the mother father other: mother father other: mother father other: terminates until further order of the court. is continued through the term of this order. is continued for the following purpose(s): BY THE COURT: Expiration Date: Circuit Court Judge DISTRIBUTION: 1. Original - Court 2. All Signers 3. Service Providers Circuit Court Commissioner Name Printed or Typed Date JD-1784, 03/12 Consent Decree (In-Home Placement Only) §§48.32 and 938.32, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com