For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Consent Decree (Out-of-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. (For an Indian child who is placed out-of-the home, use the Indian Child Welfare Act version [IW-1785] of this consent decree.) 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 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, and 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 was never entered. THE COURT FINDS: 1. The victim/family was 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. JD-1785, 03/12 Consent Decree (Out of 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 3 American LegalNet, Inc. www.FormsWorkFlow.com Consent Decree (Out of Home Placement Only) Page 2 of 3 Case No. 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. 5. The child’s/juvenile’s placement out-of-the home is maintained. a. Placement in the home at this time is is not contrary to the child’s/juvenile’s welfare. b. Reasonable efforts to prevent removal were [Complete one of the following] made by the department or agency responsible for providing services. made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child/juvenile from the home. not required under §§48.355(2d) and 938.355(2d). required, but the department or agency responsible for providing services failed to make reasonable efforts. c. Reasonable efforts to place the child/juvenile in a placement that enables the sibling group to remain together were  made. not required because the child/juvenile does not have siblings in out-of-home care. not required because it would be contrary to the safety or well being of the child/juvenile or any of the siblings. d. Permanency plan was not filed. was filed and reasonable efforts to achieve the goal(s) of the permanency plan, including through an out-of-state placement if appropriate, were [Complete one of the following only if a permanency plan was filed] made by the department or agency responsible for providing services. not made by the department or agency responsible for providing services. 6. As to the department or agency recommendation: a. The placement location recommended by the department or agency is adopted. OR b. After giving bona fide consideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted. THE COURT ORDERS: 1. The child/juvenile is placed at and into the placement and care responsibility of the county department, which has primary responsibility for providing services. Department of Children and Families, which has primary responsibility for providing services. Bureau of Milwaukee Child Welfare, which has primary responsibility for providing services. JD-1785, 03/12 Consent Decree (Out of 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 3 American LegalNet, Inc. www.FormsWorkFlow.com Consent Decree (Out of Home Placement Only) Page 3 of 3 Case No. 2. The child/juvenile has one or more siblings in out-of-home care and the child/juvenile is not placed with all those siblings. The department or agency shall make reasonable efforts to provide frequent visitation or other ongoing interaction between the child/juvenile and any siblings. The department or agency is not required to provide for frequent visitation or other ongoing interaction because it would be contrary to the safety or well being of the child/juvenile or any siblings. 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): 5. The parties must comply with all terms and conditions of the consent decree. 6. 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. 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-1785, 03/12 Consent Decree (Out of Home Placement Only) §§48.32 and 938.32, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com