Wis JI-Children 234A

The petition in this case alleges that (guardian) is unable or in need of assistance to

provide necessary special treatment or care for (child). Your role as jurors will be to answer

the following questions in the special verdict:

1. Is (guardian) unable or in need of assistance to provide necessary special treatment

or care for (child)?

2. Is (guardian) unwilling or unable to sign the petition requesting jurisdiction?

The burden of proof is on (petitioner) to convince you by evidence that is clear,

satisfactory, and convincing, to a reasonable certainty, that the questions should be answered

"yes."

"Special treatment or care" means professional services which need to be provided to

the child or the child's family to protect the well-being of the child, to prevent placement of

the child outside of the home, or to meet the special needs of the child. This term includes,

but is not limited to, medical, psychological, or psychiatric treatment; alcohol or other drug

abuse treatment; or other services that are necessary and appropriate.

"Unable or in need of assistance to provide necessary special treatment or care for"

means that (guardian) is unable to provide the treatment or care necessary to meet the special

needs of the child despite reasonable efforts of (guardian). In making this determination, you

may consider all facts and circumstances bearing on the child's need for care and the

(guardian)'s ability to provide that care, including age, physical conditions, health, and

special needs.

If you are convinced by evidence that is clear, satisfactory, and convincing, to a

reasonable certainty, that (guardian) is unable or in need of assistance to provide necessary

special treatment or care for (child), you should answer question No. 1 "yes." If you are not

so convinced, you must answer question No. 1 "no."

In answering question No. 2, "unwilling" means a willful and intentional failure to

sign. The term "unable" means an inability to sign. If you are convinced by evidence that is

clear, satisfactory, and convincing to a reasonable certainty, that (guardian) is (unwilling)

(unable) to sign the petition, you should answer the question "yes."

SPECIAL VERDICT

1. Is (guardian) unable or in need of assistance to provide necessary special

treatment or care for (child)?

Answer:__________________

Yes or No

If the answer to question No. 1 is "yes," answer question No. 2:

2. Is (guardian) unwilling or unable to sign the petition requesting jurisdiction?

Answer:__________________

Yes or No