JD-1712, 04/08 Waiver of Participation in Nonsecure Physical Custody Hearing 24724748.21(3)(am), 938.21(2)(am), and 938.21(3)(am), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Waiver of Participation in Nonsecure Physical Custody Hearing Case No. I am the juvenile 1. involved in this proceeding, alleged to be delinquent, and held in nonsecure custody. 2 . involved in this proceeding, alleged to be a habitually truant from home, and held in nonsecure custody. 3. under a ge 10, involved in this proceeding, alleged to have committed a delinquent act, and held in nonsecure custody. I am the parent/guardian/legal custodian /Indian c ustodian of the 1. child in need of protection or services involved in this proceeding who is being held in a nonsecure custodial placement. 2 . juvenile in need of protection or services involved in this proceeding who is being held in a nonsec ure custodial placement because: the parent or guardian signed the petition requesting jurisdiction; the juvenile is habitually truant from school; the juvenile is a school dropout; or the juvenile is not responsible for a delinquent act by reason of mental disease or defect. The child/juvenile is held at . I understand that I: have the right to attend the hearing in court on whether this placement should continue. have the right to have an attorney at such a hearing if I am the juvenile charged. am giving up my right to participate in a hearing at this time, but I also understand that I can request a hearing on placement at any future time for good cause. I am waiving the right to participate in a nonsecure physical custody hearing. Juvenile Name Printed or Typed Date Parent/Guardian/Legal Custodian /Indian C ustodian Name Printed or Typed Date DISTRIBUTION: 1. Court 2. District Attorney/Corporation Counsel 3. Parents /Guardian/ Legal Custodian/ Indian Custodian 4. Child/J uvenile 5 . American LegalNet, Inc. www.FormsWorkFlow.com