Fla. R. Juv. P. Form 8.961

ORDER FOR PLACEMENT IN SHELTER

THIS CAUSE came on to be heard under chapter 39, Florida

Statutes, on the sworn AFFIDAVIT AND PETITION FOR

PLACEMENT IN SHELTER CARE filed by.....(petitioner’s name).....,

on.....(date)...... The following persons appeared before the court:

..... Petitioner ……….

..... Petitioner’s attorney ……….

..... Mother ………..

..... Father(s) ……….

..... Legal custodian(s) ……….

..... Guardian ad litem ……….

..... GAL attorney ……….

..... Attorney for the Child ……….

..... Other: ……….

COMMENT: The name of the guardian ad litem and the attorney ad

litem, if appointed, must be listed on the order, even if he or she

was not present at the hearing.

and the Court having reviewed its file and having been otherwise

duly advised in the premises finds as follows:

1. The minor child(ren), .........., was/were found

within the jurisdiction of this court and is/are of an age subject to

the jurisdiction of this court.

2. PLACEMENT IN SHELTER.

..... The minor child(ren) was/were placed in shelter on

.....(date)..... at.......... a.m./p.m. by.....(name)....., a duly

authorized agent of the department.

..... The minor child(ren) need(s) to be placed in shelter at the

request of the petitioner for the reasons stated in this order.

3. PARENTS/CUSTODIANS. The parents/custodians

of the minor child(ren) are:

Name Address

Mother: .......... ..........

Father of.....(child’s name).....:

Other: .....(relationship and to which child).....

4. INABILITY TO NOTIFY AND/OR LOCATE

PARENTS/CUSTODIANS. The petitioner has made a good faith

effort to notify and/or locate, but was unable to notify and/or locate

.....(name(s))....., a parent or legal custodian of the minor child(ren).

5. NOTIFICATION. Each parent/legal custodian not listed

in #4 above was:

..... duly notified that the child(ren) was/were taken into custody;

..... duly notified to be present at this hearing;

..... served with a statement setting forth a summary of procedures

involved in dependency cases;

….. notified that if they are on active military duty, they may have

the right to certain protections under the Servicemember Civil Relief

Act (50 U.S.C. ss. 3901 et seq.);

..... advised of their right to counsel; and

..... was represented by counsel, .....(name).....

..... knowingly, voluntarily, and intelligently waived the right;

or

..... the court declined to accept the waiver because..........

..... requested appointment of counsel, but the court declined

appointment because he/she did not qualify as indigent.

..... requested appointment of counsel and counsel was

appointed.

6. PROBABLE CAUSE.

..... Based on the allegations in the Affidavit and Petition for

Placement in Shelter, there is probable cause to believe that the

child(ren) is/are dependent based on allegations of abuse,

abandonment, or neglect or substantial risk of same.

..... A finding of probable cause cannot be made at this time and

the court requires additional information to determine the risk to

the child(ren). The following information must be provided to the

court during the continuation of this hearing: .....(information to be

provided)...... This hearing is continued for 72 hours, until.....(date

and time)...... The children will remain in shelter care.

7. NEED FOR PLACEMENT. Placement of the child(ren) in

shelter care is in the best interest of the child(ren). Continuation in

the home is contrary to the welfare of the child(ren) because the

home situation presents a substantial and immediate danger which

cannot be mitigated by the provision of preventive services and

placement is necessary to protect the child(ren) as shown by the

following facts:

..... the child(ren) was/were abused, abandoned, or neglected, or

is/are suffering from or in imminent danger of injury or illness as a

result of abuse, abandonment, or neglect, specifically: ..........

..... the custodian has materially violated a condition of placement

imposed by the court, specifically: ..........

..... the child(ren) has/have no parent, legal custodian, or

responsible adult relative immediately known and available to

provide supervision and care, specifically: ..........

8. REASONABLE EFFORTS.

..... Reasonable efforts to prevent or eliminate the need for

removing the child(ren) from the home have been made by the

department, which provided the following services to the family:

..... The following specific services, if available, could prevent or

eliminate the need for removal or continued removal of the child

from the home..........

..... The date these services are expected to be available is..........

..... The department is deemed to have made reasonable efforts to

prevent or eliminate the need for removal from the home because:

..... The first contact with the department occurred during an

emergency.

..... The appraisal of the home situation by the department

indicates a substantial and immediate danger to the child(ren)

which cannot be mitigated by the provision of preventive services.

..... The child(ren) cannot safely remain at home because no

services exist that can ensure the safety of the child(ren). Services

are not available because..........

..... Even with appropriate services, the child(ren)’s safety

cannot be ensured.

..... The department has made reasonable efforts to keep siblings

together after the removal from the home. The reasonable efforts of

the department were..........

..... It is not in the best interest of each child that all the siblings

be placed together in out-of-home care because..........

9. RELATIVE PLACEMENT.

..... The court asked any parents present whether the parents have

relatives that might be considered as a placement for the child(ren).

..... The court advised any parents present that the parents have a

continuing duty to inform the department of any relative who

should be considered for placement of the child.

..... By this order, the court notifies the relatives who are providing

out-of-home care for the child(ren) of the right to attend all

subsequent hearings, to submit reports to the court, and to speak

to the court regarding the child(ren), if they so desire.

It is, therefore, ORDERED AND ADJUDGED, as follows:

..... 1. The child(ren) shall remain/be placed in the shelter

custody of:

..... the department, with the department having the

discretion to shelter the child(ren) with a relative or other

responsible adult on completion of a positive homestudy, abuse

registry, and criminal background checks. The department shall

have placement and care responsibility while the child(ren) is/are

under protective supervision in an out-of-home placement.

..... all the children shall be placed together in a foster home

if available.

..... a foster home is not available for all the children because

..... placement of all the children in the same foster home is not in

the best interest of the child(ren).....(identify the child(ren)).....

because..........

..... Other: ..........

2. The child(ren)..... may..... may not be returned to the

parent/custodian without further order of this court.

3. a. The Guardian Ad Litem Program is appointed.

b. An attorney shall be appointed for..........,

..... the child/children has/have special needs as defined in

section 39.01305, Florida Statutes.

..... it is necessary.

4. The parents, within 28 days of the date of this order,

shall provide to the department the information necessary to

accurately calculate child support under section 61.30, Florida

Statutes. The parents shall pay child support in accordance with

Florida Statutes.

5. The legal custodian, or in the absence of the legal

custodian, the department and its agents, are hereby authorized to

provide consent for and to obtain ordinary and necessary medical

and dental treatment and examination for the above child(ren)

including blood testing deemed medically appropriate, and

necessary preventive care, including ordinary immunizations and

tuberculin testing.

6. Visitation with the child(ren) shall be as follows:

By the parents..........

Between the sibling children..........

Visitation or interaction between the children.....(identify

child(ren))..... is not ordered as it will be contrary to the safety or

well-being of.....(identify child(ren)) because..........

7. The parents shall provide to the court and all parties

identification and location information regarding potential relative

placements.

8. The relatives who are providing out-of-home care for the

child(ren) have the right to attend all subsequent hearings, to

submit reports to the court, and to speak to the court regarding the

child(ren), if they so desire.

9. THE COURT ADVISED THE PARENTS:

A. TO TAKE ACTION TO COMPLY WITH THE CASE

PLAN SO PERMANENCY WITH THE CHILD MAY

OCCUR WITHIN THE SHORTEST PERIOD OF TIME

POSSIBLE, BUT NO LATER THAN 1 YEAR AFTER

REMOVAL OR ADJUDICATION OF THE CHILD.

B TO STAY IN CONTACT WITH THEIR ATTORNEY

AND THEIR CASE MANAGER AND PROVIDE UPDATED

CONTACT INFORMATION IF THE PARENTS’ PHONE

NUMBER, ADDRESS, OR E-MAIL ADDRESS CHANGES.

C. TO NOTIFY THE PARTIES AND THE COURT OF

BARRIERS TO COMPLETING CASE PLAN TASKS

WITHIN A REASONABLE TIME AFTER DISCOVERING

SUCH BARRIERS.

D. THAT IF THE PARENTS FAIL TO

SUBSTANTIALLY COMPLY WITH THE CASE PLAN

THEIR PARENTAL RIGHTS MAY BE TERMINATED

AND THE CHILD(REN)’S OUT-OF-HOME PLACEMENT

MAY BECOME PERMANENT.

10. Special conditions: ..........

11. This court retains jurisdiction over this matter to enter

any other and further orders as may be deemed to be in the best

interest and welfare of this/these child(ren).

12. If a Petition for Dependency is subsequently filed in this

cause, the Arraignment Hearing is scheduled for.....(date)....., at

.......... a.m./p.m. at.....(location of arraignment)...... The

parents have a right to be represented by an attorney at the

arraignment hearing and during the dependency proceedings.

COMMENT: The following paragraph must be in bold, 14 pt. Times

New Roman or Courier font.

If you are a person with a disability who needs any

accommodation in order to participate in this proceeding, you

are entitled, at no cost to you, to the provision of certain

assistance. Please contact …..(name, address, telephone

number)….. at least 7 days before your scheduled court

appearance, or immediately upon receiving this notification if

the time before the scheduled appearance is less than 7 days.

If you are hearing or voice impaired, call 711.

ORDERED in.......... County, Florida on.....(date)....., at

.......... a.m./p.m.

Circuit Judge