Florida Juvenile Procedure Rule 8.870
RULE 8.870. ORDER
(a) Requirement to Attend School. If the court determines
that a student did miss any of the alleged days, the court shall
order the student to attend school and the parent, guardian, legal
custodian, or, if the student is in foster care, the case manager, to
ensure that the student attends school.
(b) Other Sanctions. If the court determines that a student
did miss any of the alleged days, the court may order any of the
following:
(1) The student to participate in alternative sanctions
to include mandatory attendance at alternative classes to be
followed by mandatory community service hours for up to six
months;
(2) The student or the student’s parent, guardian, or
legal custodian, to participate in homemaker or parent aid services;
(3) The student or the student’s parent, guardian, or
legal custodian to participate in and complete intensive crisis
counseling and/or community mental health services;
(4) The student and the student’s parent, guardian, or
legal custodian to participate in services provided by voluntary or
community agencies as available;
(5) The student or the student’s parent, guardian, or
legal custodian to participate in vocational, job training, or
employment services.
(c) Referral to Case Staffing Committee. If the student
does not successfully complete the sanctions ordered, the case shall
be referred to the case staffing committee, with a recommendation
to file a child in need of services petition under Chapter 984, Florida
Statutes.
(d) Participation by Parent, Guardian, Legal Custodian,
or Student. The parent, guardian, or legal custodian and the
student shall participate as ordered or required by the court, in any
sanction or services ordered pursuant to this rule.
(e) Enforcement by Contempt. The court shall enforce
such requirements through its contempt power, pursuant to
Chapter 984, Florida Statutes.
PART VI. FORMS FOR USE WITH RULES OF JUVENILE
PROCEDURE
The following forms are sufficient for the matters that are
covered by them. So long as the substance is expressed without
prolixity, the forms may be varied to meet the facts of a particular
case. Captions, verifications, and certificates of service, except for
the designation of the paper, are omitted from most forms. General
forms for these are provided at the beginning of the forms.
Publisher’s Note
The Florida Supreme Court’s per curiam opinion of December
24, 1980 (393 So.2d 1077) in which the forms appear provides:
“Nothing in the Forms shall be deemed to be a part of these Rules.”
Committee Note
1991 Amendment. These forms have been updated to
conform to revisions to Chapter 39, Florida Statutes, and the
Florida Rules of Juvenile Procedure. As the court has stated before,
the forms are not intended to be part of the rules and are provided
for convenience only.
A. GENERAL FORMS
FORM 8.901. CAPTION OF PLEADINGS AND ORDERS
NAME OF COURT
In the Interest of
...................., .....a child/children.....
.....(Designation of Pleading or Order).....
FORM 8.902. VERIFICATION
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared
.....(name)....., who, being sworn, says the .....(document)..... is filed
in good faith and on information, knowledge, and belief is true.
Sworn to and subscribed before me on .....(date)......
(Title)
Committee Notes
1991 Adoption. The above verification should be added to
petitions and motions as required by law.
FORM 8.903. CERTIFICATE OF SERVICE
I certify that a copy of .....(document)..... has been furnished to
.....(name(s))..... by .....e-mail/U.S. mail/hand delivery/fax..... on
.....(date)......
(Title)
Committee Notes
1991 Adoption. The above may be added to petitions, orders,
and other forms as required.
FORM 8.904. AFFIDAVIT FOR ORDER TO TAKE INTO
CUSTODY
AFFIDAVIT
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared affiant,
who, being sworn, made the following allegation of facts:
.................... and requested that the court issue an order to take
into custody the below.....named/described..... children.
Name(s) ……….
Age(s) ……….Sex ……….
Date(s) of Birth ……….
Race ……….
Address ……….
Identifying Description ……….
Parent/Custodian……….
Address ………..
Affiant
.....Address.....
FORM 8.905. ORDER TO TAKE INTO CUSTODY
ORDER TO TAKE INTO CUSTODY
TO: ……….
A .....verified petition/affidavit..... having been filed in this case,
alleging facts which under existing law are determined to be
sufficient to authorize taking into custody the below-
.....named/identified..... .....child/children....., believed to be of an
age subject to the juvenile jurisdiction of the circuit court; therefore
You are commanded to take the following .....child/children..... into
custody:
Name(s)……….
Age(s) ………. Sex ……….
Date(s) of Birth ……….
Race ……….
Address ……….
Identifying Description ……….
Parent/Custodian ……….
Address . ……….
For the following reasons:……….
Upon taking the .....child/children..... into custody, you will
deliver .....him/her/them..... to: ……….to be held pending a
.....detention/shelter..... hearing or upon further order of this court.
ORDERED in the circuit court in and for .................... County,
Florida, on .....(date)......
Circuit Judge
RETURN
This order to take into custody was executed at ..... m., on
.....(date)....., by the undersigned.
(Title)
RETURN TO ISSUING COURT UPON THE CHILD’S 19TH
BIRTHDAY
FORM 8.906. RELEASE ORDER
RELEASE ORDER
The court now finding that the above-named
.....child/children....., previously .....placed in shelter
care/detained....., should be released.
It is ADJUDGED:
1. That ……….shall be released immediately to ……….
2. It is FURTHER ADJUDGED that ………..
ORDERED in the circuit court in and for ……….County,
Florida, on .....(date)......
Circuit Judge
FORM 8.907. TRANSFER ORDER
TRANSFER ORDER
This case being before this court for consideration of transfer
to a court having juvenile jurisdiction in another county, the court
finds:
1. That on .....(date)....., following a hearing on the petition
of ...................., the court .....entered an order of
adjudication/withheld adjudication/accepted a plan of proposed
treatment, training, or conduct......
2. That it would be in the best interest of the above-named
.....child/children..... that this case be transferred to the circuit
court of another county because: ....................
3. That a dispositional order .....was/was not..... made in
this case.
It is recommended to the receiving court that: .....................
It is ADJUDGED:
1. That the jurisdiction of this court in this case and of the
.....child/children..... involved is transferred to the circuit court in
and for .................... County, Florida, of the ..... Judicial Circuit, for
any and all proceedings deemed necessary.
2. That within 5 days from the date of this order the clerk of
this court shall forward a certified copy of:
(a) The order of transfer, which shall include but not be
limited to:
(i) Specific offense that the child was found to have
committed;
(ii) Degree of offense;
(iii) Name of parent/custodian to be summoned;
(iv) Address at which the child should be summoned for
disposition;
(v) Name and address of the victim; and
(vi) Whether the child was represented by counsel.
(b) A certified copy of the delinquency petition;
(c) A copy of the juvenile referral or complaint; and
(d) Any reports and all previous orders including orders
appointing counsel entered by the court in the interest of that child.
These documents shall be forwarded to the clerk of the
receiving court; state attorney of the receiving court; public
defender of the receiving court, if counsel previously has been
appointed; and ……….
ORDERED in the circuit court in and for .................... County,
Florida, on .....(date)......
Circuit Judge
FORM 8.908. SUMMONS
SUMMONS
STATE OF FLORIDA
TO ...................., .....a child/children..... and ..................,
.....parent(s)/custodian.....:
A petition under oath has been filed in this court alleging the
above-named .....child/children..... to be .................... under the
laws of the State of Florida, a copy of which was attached hereto;
You are to appear before the Honorable ...................., Circuit
Judge, at .....m., on .....(date)....., at the county courthouse of
.................... County, at ...................., Florida for the hearing of
this petition. The .....parent(s)/custodian..... .....is/are..... required
to produce the .....child/children..... at that time and place unless
the .....child/children..... .....is/are..... in detention or shelter care at
that time.
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 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.
You may be held in contempt of court if you fail to appear.
WITNESS my hand and seal of this court at ....................
County, Florida, on .....(date)......
………., Clerk of Circuit Court
……….County, Florida
By: D.C.,
FORM 8.909. PLAN FOR TREATMENT, TRAINING, OR
CONDUCT
PLAN FOR TREATMENT, TRAINING, OR CONDUCT
TO: ………., Circuit Judge
Instead of a plea to the petition filed on .....(date)....., alleging
the above-named .....child/children..... to be ………., the following
proposed plan for treatment, training, or conduct, formulated in
conjunction with the supervising agency, is now submitted, with
the request that it be accepted by the court and that prosecution of
the said petition be deferred.
This agreement is entered into with full knowledge and
disclosure of all the facts and circumstances of this case, and in
consideration thereof, and the promise of fulfillment of its terms
and conditions, each of the undersigned agrees as follows: ……….
It is further agreed:
1. That the speedy trial rule is waived,
2. That a hearing for the acceptance of this plan .....is/is
not..... waived,
3. That this plan, as agreed to here, shall be in effect until
...............
In witness whereof the undersigned have affixed their hands
on .....(date)......
Child
.....Parent(s) or Custodian(s).....
Attorney for
.....Child/Parent(s)/Custodian(s).....
………., Department of Juvenile Justice, Supervising Agency,
Recommends: .....Acceptance/Rejection......
Authorized Agent
CONSENT IN DELINQUENCY CASES
The undersigned, being familiar with the contents of this plan
for treatment, training, or conduct and the delinquency petition on
which it is based, consents to defer prosecution of the petition.
Dated: ……….
……….
State Attorney
By:
Assistant State Attorney
ORDER
The foregoing plan for treatment, training, or conduct having
been properly submitted and having been given consideration by
the court,
It is ADJUDGED:
1. That the plan is approved and the parties thereto
shall comply with its terms and conditions.
2. That the plan is disapproved and an adjudicatory
hearing on the petition shall be scheduled.
ORDERED at ...................., .................... County, Florida, on
.....(date)......
Circuit Judge
FORM 8.911. UNIFORM CHILD CUSTODY JURISDICTION AND
ENFORCEMENT ACT AFFIDAVIT
See Fla. Sup. Ct. App. Fam. L. Form 12.902(d).
FORM 8.912. PETITION TO SHOW CAUSE
PETITION BY AFFIDAVIT FOR ORDERTO SHOW CAUSE
1. This is a proceeding for an order to show why the below-
named witness, ...................., should not be held in contempt of
court.
2. Petitioner is .....(title)......
3. A subpoena was duly served on .....(name)....., at
.....(time)..... by .....(name)..... who was then and there authorized to
serve said subpoena. A copy of the receipt evidencing service is
attached and incorporated by reference. Said .....(name)..... did not
appear on .....(date)....., at .....(time)..... in response to that
subpoena and to this date has not appeared.
WHEREFORE, the undersigned does respectfully request the
court to issue an order to direct .....(name)..... to appear before the
court to show cause why .....(name)..... should not be held in
contempt of court.
Petitioner
FORM 8.913. ORDER TO SHOW CAUSE
ORDER TO SHOW CAUSE
This cause came on to be heard on the petition for order to
show cause directed to .....(name)..... for failure .....(specify)..... on
.....(date)...... (See attached affidavit.)
NOW, THEREFORE, you, .....(name)....., are hereby ORDERED
to appear before this court located at ...................., on .....(date).....,
at .....(time)....., to show cause why you should not be held in
contempt of this court, for your failure to .....(specify)......
DONE AND ORDERED on .....(date)....., at ....................,
.................... County, Florida.
Circuit Judge
B. DELINQUENCY FORMS
FORM 8.929. DETENTION ORDER
DETENTION HEARING ORDER
Pick up order for absconding from:
..... supervised release
..... probation
..... commitment
..... other: ..................
Pick up order for:
..... violation of probation
..... violation of probation for an underlying felony firearm offense not
involving a new law violation
..... other: ..................
Present before the court:
..... the child;
..... .....(name)....., Assistant State Attorney;
..... .....(name)....., Assistant Public Defender/defense attorney;
..... .....(name)....., parent/legal guardian;
..... .....(name)....., DJJ juvenile probation officer;
..... .....(name)....., Department of Children and Family Services
..... .....(name)....., guardian ad litem
DJJ Supervision status:
..... None
..... Supervised release ..... with or ..... without an electronic monitor
..... Probation
..... Committed to ..... level
..... CINS/FINS
..... Conditional release
Other court involvement:
Dependency: ..... Yes ..... No ..... Unknown
Domestic relations: ..... Yes ..... No ..... Unknown
Domestic violence: ..... Yes ..... No ..... Unknown
The court finds that the child was taken into custody at ..... a.m./p.m.,
on .....(date)......
Probable cause that the child committed delinquent acts was:
..... found.
..... found for lesser included offense …...
..... not found.
..... reset within ….. hours of custody.
Risk assessment instrument (RAI) score: ..........
Score amended to: ..........
..... Meets detention criteria.
..... Meets detention criteria for being a Prolific Juvenile Offender.
IT IS ORDERED that the above-named child be:
..... released to the custody of .....(name)......
..... held in secure detention for domestic violence charge under section
985.255, Florida Statutes.
The court finds:
..... respite care is not available for the child; and
..... it is necessary to place the child in secure detention to protect the
victim from injury.
..... detained by the Department of Juvenile Justice in
..... supervised release.
….. days
..... supervised release with electronic monitoring.
..... supervised release with electronic monitoring due to being a
Prolific Juvenile Offender.
..... secure detention.
….. days
..... secure detention due to probable cause being found for a
designated offense and a risk to public safety and a danger
to the community.
with the following special conditions:
..... attend school regularly.
..... attend evaluation as follows:
..... physical.
..... psychological.
..... ADM.
..... other .....................
..... no (..... harmful) contact with .....(name)......
..... drug testing.
..... no drug and alcohol use.
..... other: ....................
Reasons for court ordering more or less restrictive placement than RAI
score:……….
It is FURTHER ORDERED that unless an adjudicatory hearing has begun or a
subsequent modification order is entered, the child must be released no later
than 5:00 p.m. on .....(date)..... to .....(name(s))....., who is/are
..... the parent(s)
..... a relative
..... foster care
..... ………. program
..... .....him/her..... self
..... other .....................
IT IS FURTHER ORDERED under section 985.039, Florida Statutes
..... The parent/guardian of the child, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL
32399-3100, $5 per day for each day the juvenile is in secure detention.
..... The parent/guardian of the child, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL
32399-3100, $1 per day for each day the child is on supervised release.
..... The parent/guardian of the child, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL
32399-3100, a REDUCED rate of $..... per day for each day the child is
in detention status. This reduced fee is based on the court’s finding
..... that the parent/guardian was the victim of the delinquent
act or violation of law for which the child is currently
detained and is cooperating in the investigation of the
offense; or
..... of indigency or significant financial hardship. The facts
supporting this finding are: ....................
..... The parent/guardian of the child, .....(name)....., .....(address)....., is liable
for .....% of the payment. The parent/guardian of the child, .....(name).....,
.....(address)....., is liable for .....% of the payment.
..... The .....supervision fee/cost of care..... is WAIVED based on the court’s
finding
..... that the parent/guardian was the victim of the delinquent act or
violation of law for which the child is currently detained and is
cooperating in the investigation of the offense; or
..... of indigency or significant financial hardship. The facts supporting
this finding are: ....................
If the child’s case is dismissed or if the child is found not guilty of the
charges or court order, then the parent/guardian is not liable for fees under
this order.
Unless modified by subsequent notice, the NEXT COURT APPEARANCE:
..... will be at .....(time)..... on .....(date)..... at .....(location).......
..... is to be set.
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.
Note: The child’s parent/legal guardian must advise Clerk’s Office and DJJ of
any address change.
..... Department of Juvenile Justice must transfer the child to ....................
Detention Center.
Other: ......................
DONE AND ORDERED in ................. County, Florida at ..........
a.m./p.m. on .....(date).....
Circuit Judge
Copies to: ....................
FORM 8.930. JUVENILE NOTICE TO APPEAR
JUVENILE NOTICE TO APPEAR
DATE .......... AGENCY ………..
CASE NO. ……….
PARENT, ADULT RELATIVE, LEGAL GUARDIAN .....(name).....
I am the .....(relationship to child)..... of .....(child’s name).....
and promise to ensure that the child appears on .....(date)..... at
.....(time)..... at .....(location)...... I also promise immediately to notify
the office of the state attorney at .....(telephone number)..... and the
clerk of the court at .....(telephone number)..... of any change in the
child’s address.
Signature of Parent/Adult
Relative/Legal Guardian
.....(address).....
.....(telephone number).....
.....(date).....
.....(address and telephone number
of child, if different).....
---------------
I, .....(child’s name)....., understand that I have been charged
with a law violation, .....(offense(s))....., and that I am being released
at this time to the custody of .....(parent, adult relative, or legal
guardian’s name)......
I promise to appear on .....(date)..... at .....(time)..... at
.....(location)....., and to appear as required for any additional
conferences or appearances scheduled by DJJ or the court. I
understand that my failure to appear shall result in a custody order
being issued and that I will be picked up and taken to detention.
Child’s Signature
Date ....................
Arresting Officer ....................
Releasing officer or DJJ
counselor authorizing release
DJJ Intake Telephone Number …………
ATTACH TO ARREST AFFIDAVIT
FORM 8.931. DELINQUENCY PETITION
PETITION
Your petitioner respectfully represents that ………. whose
date(s) of birth …. is/are ….. and who reside(s) at ………. ...is/ are
….. delinquent and that this court has jurisdiction of this cause
because of the following allegations of facts:……….
That the parents or custodians are:
…………………..
…………………….
Mother
Residence
…………………..
…………………….
Father
Residence
…………………..
…………………….
Custodian Residence
WHEREFORE, your petitioner requests process may issue to
bring the above-named parties before the court on a day and time
designated to be dealt with according to law.
Dated: ....................
Petitioner
FORM 8.932. APPLICATION FOR COUNSEL AND ORDER
APPLICATION FOR COUNSEL
AND ORDER
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared
affiant, who, being duly sworn, says:
1. That I understand a delinquency complaint has been
made against me and, being advised of my right to an attorney, now
request appointment of counsel.
2. Being without sufficient funds, property or assets of any
kind, I will be deprived of my right to representation unless I am
adjudged insolvent and counsel appointed to represent me.
3. That I have been informed that a lien for the value of the
legal services rendered to me by the public defender may be
imposed by law on any property I now or may hereafter have in this
state.
Dated: ....................
Affiant Child
STATEMENT OF PARENT(S)
The undersigned are informed and understand that liability for
cost of representation of this child by the public defender can be
assessed against the parent(s) by court order in an amount not to
exceed the amount provided by law.
Parent
Parent
ORDER
The court finds that this child is indigent, as defined by law,
and is desirous of counsel; it is, therefore,
ORDERED
1. That this child is declared to be insolvent.
2. That ...................., Public Defender for the ..... Judicial
Circuit, State of Florida, is hereby appointed as counsel to
represent this child in all matters in defense of the delinquency
complaint herein made.
DONE AND ORDERED in the circuit court in and for
.................... County, Florida, on .....(date)......
Circuit Judge
FORM 8.933. WAIVER OF COUNSEL
WAIVER OF COUNSEL
I GIVE UP MY RIGHT TO HAVE A LAWYER
1. I understand that a lawyer is a professional person who is
trained in the law and whose job it is to help people who have legal
problems.
2. I understand that if I have a lawyer, that person will do
several things to help me, such as:
a. Explaining the charges which have been filed against me in
the petition for delinquency.
b. Giving me advice on my rights and responsibilities in this
case.
c. Advising me as to what legal defenses may be available to
me.
d. Advising me as to whether or not I should challenge the
charges.
e. Helping me prepare my case for hearing if I decide to
challenge the charges.
f. Helping me get the proper witnesses to court.
g. Giving me advice and direction on what I should do
regarding my case.
3. I understand that I have a right to be represented by a
lawyer at any time and that if I cannot pay to hire a lawyer, the
judge will give one to me. In signing this paper, I understand that I
choose not to have a lawyer represent me at this time.
4. I understand that I keep the right to have a lawyer. I can
ask the judge at any time to give me a lawyer even if I have not
asked for one before.
5. A lawyer has explained to me my right to be represented in
this case, the results of not having a lawyer and other factors that
would help me to decide whether or not to have a lawyer in this
matter. I have had time to ask questions and have my questions
answered to my satisfaction, including questions about immigration
and other consequences.
6. I understand all of the above statements regarding my
rights to a lawyer but, I give up my right to be represented by a
lawyer at this time.
Date: ....................
Child Age
STATEMENT OF ATTORNEY ASSIGNED TO DISCUSS THE WAIVER
WITH THE CHILD
I have read this waiver to the child. I have explained the
waiver fully to the child and believe that the child has waived
counsel knowingly, intelligently, and voluntarily.
Date:……….
Attorney
FORM 8.934. ORDER TO DETERMINE MENTAL CONDITION
ORDER TO DETERMINE
MENTAL CONDITION
It having been made known to the court and the court finding
that reasonable grounds exist to believe that this child may be
incompetent to proceed with an adjudicatory hearing, and that a
hearing should be scheduled to examine this child and determine
.....his/her..... mental condition, it is
ADJUDGED:
1. That all proceedings in this case are now stayed, pending
further order of this court.
2. That a hearing to determine the mental condition of this
child is scheduled before me at ..... m., on .....(date)......
3. That the following named persons are hereby appointed
as disinterested qualified experts to examine this child as to
competency and to testify as to the child’s mental condition at the
hearing above scheduled:
(1) .....................................
.........................................................
Name Address
(2) .....................................
.........................................................
Name Address
(3) .....................................
.........................................................
Name Address
4. That this child shall be held temporarily in the custody of
...................., who shall produce the child for examination by the
above-named at a time and place to be arranged.
ORDERED at ...................., .................... County, Florida, on
.....(date)......
Circuit Judge
FORM 8.935. ORDER OF INCOMPETENCY
ORDER OF INCOMPETENCY
The above-named child being before the court for inquiry into
.....his/her..... mental condition and a determination of
.....his/her..... competency to proceed with an adjudicatory hearing,
from the evidence the court finds:
That the said child is mentally incompetent to proceed with
the adjudicatory hearing.
It is, therefore, ADJUDGED that proceedings shall be
commenced immediately for the involuntary hospitalization of this
child by ...................., as provided by law, and the said child shall
.................... pending disposition of those proceedings.
All proceedings in this case are stayed pending such action.
ORDERED at ...................., Florida, on .....(date)......
Circuit Judge
FORM 8.936. ORDER OF COMPETENCY
ORDER OF COMPETENCY
The above-named child being before the court for inquiry into
.....his/her..... mental condition and a determination of
.....his/her..... competency to proceed with an adjudicatory hearing,
from the evidence the court finds:
That the child is mentally competent to proceed with the
adjudicatory hearing.
It is, therefore, ADJUDGED that the adjudicatory hearing in
this case shall .....commence/resume..... at ..... m., on .....(date)......
ORDERED at ...................., Florida, on .....(date)......
Circuit Judge
FORM 8.937. DEMAND FOR VOLUNTARY WAIVER
DEMAND FOR VOLUNTARY WAIVER
OF JURISDICTION
The child files this demand for voluntary waiver of jurisdiction
pursuant to rule 8.105, Florida Rules of Juvenile Procedure, and
shows that the child desires the court to waive jurisdiction and
certify the case for trial in adult court as if the child were an adult
to face adult punishments or penalties.
Date: ....................
Child
Parent/Legal Guardian
FORM 8.938. ORDER OF VOLUNTARY WAIVER
VOLUNTARY WAIVER ORDER
Upon the demand for voluntary waiver filed by the child, it is
hereby ORDERED AND ADJUDGED as follows:
1. A demand for voluntary waiver of jurisdiction was filed by
the child and parent/legal guardian on .....(date)......
2. The court waives jurisdiction to try the child pursuant to
chapter 985, Florida Statutes.
3. The above cause is certified for trial as if the child were
an adult.
4. A certified copy of this order shall be furnished to the
clerk of the court having jurisdiction to try the child as an adult
and to the prosecuting officer of said child.
5. The child shall be forthwith delivered to the sheriff of the
county in which the court that is to try the child is located. Bond is
set at $...........
DONE AND ORDERED in chambers at ................,
.....(date)......
Circuit Judge
FORM 8.939. MOTION FOR INVOLUNTARY WAIVER
MOTION FOR INVOLUNTARY WAIVER
The State of Florida, having considered the recommendation of
the intake officer, petitions the court to waive jurisdiction pursuant
to rule 8.105, Florida Rules of Juvenile Procedure, and shows:
The child was 14 or more years of age at the alleged time of
commission of the violation of law for which the child is charged.
[Add the following paragraph, if applicable]
The child has been previously adjudicated delinquent for a
violent crime against a person, to wit .....(offense)....., and is
currently charged with a second or subsequent such offense.
Wherefore, the State of Florida requests the court to conduct a
hearing on this motion for the purpose of determining whether the
court should waive its jurisdiction and certify the case to the
appropriate court for trial as if the child were an adult.
Petitioner
FORM 8.940. MOTION TO COMPILE REPORT
MOTION TO COMPILE REPORT
The State of Florida, having filed a petition for involuntary
waiver, moves the court for an order requiring the department to
prepare a study and report to the court, in writing, considering the
following relevant factors:
1. The seriousness of the alleged offense to the community
and whether the protection of the community is best served by
transferring the child for adult sanctions.
2. Whether the alleged offense was committed in an
aggressive, violent, premeditated, or willful manner.
3. Whether the alleged offense was against persons or
against property.
4. The probable cause as found in the report, affidavit, or
complaint.
5. The desirability of trial and disposition of the entire
offense in one court when the child’s associates in the alleged crime
are adults or children who are to be tried as adults who will be or
have been charged with a crime.
6. The sophistication and maturity of the child.
7. The record and previous history of the child including:
a. Previous contact with the department, other law
enforcement agencies, and the courts;
b. Prior periods of juvenile probation;
c. Prior adjudications that the child committed a
delinquent act or violation of law, greater weight being given if the
child previously had been found by a court to have committed a
delinquent act involving an offense classified as a felony or had
twice previously been found to have committed a delinquent act
involving an offense classified as a misdemeanor; and
d. Prior commitments to institutions.
8. The prospects for adequate protection of the public and
the likelihood of reasonable rehabilitation of the child, if found to
have committed the alleged offense, by the use of procedures,
services, and facilities currently available to the court.
WHEREFORE, the State of Florida requests an order directing
the department to prepare a study and report in writing prior to the
waiver hearing.
Petitioner
FORM 8.941. ORDER TO COMPILE REPORT
ORDER TO COMPILE REPORT
Upon the motion of the State of Florida, the department shall
prepare a study and report to the court, in writing, considering the
following relevant factors:
1. The seriousness of the alleged offense to the community
and whether the protection of the community is best served by
transferring the child for adult sanctions.
2. Whether the alleged offense was committed in an
aggressive, violent, premeditated, or willful manner.
3. Whether the alleged offense was against persons or
against property.
4. The probable cause as found in the report, affidavit, or
complaint.
5. The desirability of trial and disposition of the entire
offense in one court when the child’s associates in the alleged crime
are adults or children who are to be tried as adults who will be or
have been charged with a crime.
6. The sophistication and maturity of the child.
7. The record and previous history of the child including:
a. Previous contact with the department, other law
enforcement agencies, and the courts;
b. Prior periods of juvenile probation;
c. Prior adjudications that the child committed a
delinquent act or violation of law, greater weight being given if the
child had previously been found by a court to have committed a
delinquent act involving an offense classified as a felony or had
twice previously been found to have committed a delinquent act
involving an offense classified as a misdemeanor; and
d. Prior commitments to institutions.
8. The prospects for adequate protection of the public and
the likelihood of reasonable rehabilitation of the child, if found to
have committed the alleged offense, by the use of procedures,
services, and facilities currently available to the court.
DONE AND ORDERED in chambers at ...................., Florida,
.....(date)......
Circuit Judge
FORM 8.942. ORDER OF INVOLUNTARY WAIVER
ORDER OF INVOLUNTARY WAIVER
A petition was filed in this cause on .....(date)...... Prior to the
adjudicatory hearing on the petition, the State of Florida filed a
motion requesting that the court waive its jurisdiction and certify
the case to the appropriate court for trial as if the child were an
adult. This cause came before the court on the motion.
The following were present .....(names)..... with .....(name).....,
representing the State of Florida and .....(name)....., representing
the Department of Juvenile Justice.
The court heard the evidence presented by the State of Florida
and the child to determine whether the jurisdiction of this court
should be waived and the case certified to the appropriate court for
trial as if the child were an adult. The court finds that it is in the
public interest that the jurisdiction of this court be waived and that
the case be certified to the appropriate court having jurisdiction to
try an adult who is charged with a like offense based on the
following findings of fact:
1. Age of child ..........
2. Seriousness of alleged offense ....................
3. Manner of commission of offense ....................
4. Nature of offense (person or property) ....................
5. Probable cause as found in the report, affidavit, or
complaint ....................
6. Desirability of trial and disposition of entire offense in
one court ....................
7. Sophistication and maturity of the child ....................
8. Record and previous history of the child ....................
9. Prospects for adequate protection of the public and
rehabilitation of child .............
IT IS ADJUDGED that the jurisdiction of this court is waived
and that this case is transferred to the .....(court)..... for trial as if
the child were an adult.
The child shall be held by the sheriff of this county unless a
bond in the amount of $.......... is posted. The child shall appear
before .....(court)..... on .....(date)..... to answer the State of Florida
on the foregoing charges.
DONE AND ORDERED in chambers at ...................., Florida,
on .....(date)......
Circuit Judge
FORM 8.947. DISPOSITION ORDER — DELINQUENCY
DISPOSITION ORDER
A petition was filed on .....(date)....., alleging .....(name)....., ….. age, to be
a delinquent child. The court finds that it has jurisdiction of the proceedings.
Present before the court were:
.....the child;
..... .....(name)....., Assistant State Attorney;
..... .....(name)....., Assistant Public Defender/defense attorney;
..... .....(name)....., guardian;
..... .....(name)....., DJJ juvenile probation officer.
At the hearing on .....(date)....., after ….. entry of a plea/an adjudicatory
hearing…..the child was found to have committed the delinquent acts listed
below:
Count Count Count Count
Charge .......... .......... .......... ..........
Lesser .......... .......... .......... ..........
Maximum .......... .......... .......... ..........
Degree .......... .......... .......... ..........
Guilty .......... .......... .......... ..........
Nolo contendere .......... .......... .......... ..........
Nolo prose .......... .......... .......... ..........
Adjudicated .......... .......... .......... ..........
Adj. withheld .......... .......... .......... ..........
The predisposition report was ..... received and considered/waived by the
child .....
The court, having considered the evidence and comments offered by
those present, having inquired, and being otherwise fully advised in the
premises ORDERS THAT:
..... Adjudication of delinquency is withheld.
..... The child is adjudicated delinquent……
..... The child is committed to a licensed child caring agency
..... The child is committed to the Department of Juvenile Justice for
placement in:
..... a moderate risk residential commitment program, for an
indeterminate period, but no longer than the child’s 21st birthday
or the maximum term of imprisonment an adult may serve for each
count listed above, whichever comes first, because
..... the child is before the court for a violation of section
790.22(3), Florida Statutes;
..... the child is before the court for the disposition of a felony;
..... the child has previously been adjudicated or had
adjudication withheld for a felony offense;
..... the child previously has been adjudicated or had
adjudication withheld for three or more misdemeanor
offenses within the previous 18 months;
..... the child is before the court for disposition for a violation of
sections 800.03, 806.031, or 828.12, Florida Statutes; or
..... the court finds by a preponderance of the evidence that the
protection of the public requires such placement or that the
particular needs of the child would be best served by such
placement. The facts supporting this finding are: ...........
..... a high-risk commitment program, for an indeterminate period, but
no longer than the child’s 21st birthday or the maximum term of
imprisonment an adult may serve for each count listed above,
whichever comes first.
..... a maximum-risk commitment program, for an indeterminate
period, but no longer than the child’s 21st birthday or the
maximum term of imprisonment an adult may serve for each count
listed above, whichever comes first, because the child meets the
criteria in section 985.465 or 985.494, Florida Statutes.
..... The child is allowed .......... days credit for time spent in secure detention
or incarceration before this date.
..... The child must be placed in secure detention until residential placement.
..... The court has orally pronounced its reasons for adjudicating and
committing this child.
..... The court retains jurisdiction to accept or reject the discharge of this
child from commitment, as provided by law.
..... The court orders that, following commitment, the child is to be:
..... directly discharged on release from commitment.
..... transitioned from a residential commitment program to a
conditional release program. Any period of conditional release may
not exceed the child’s 21st birthday or the maximum term of
imprisonment an adult could receive for each count listed above,
whichever comes first.
..... CONDITIONS OF CONDITIONAL RELEASE: On release from the
commitment program the child must abide by the following conditions
under section 985.46(5), Florida Statutes:
The Child must participate in an educational program if of a compulsory
school-attendance age under sections 1003.21(1) and (2)(a), Florida Statutes. If
the child is of a noncompulsory school-attendance age and has not received a
high school diploma or its equivalent, then the Child must participate in an
educational program or career and technical education course of study. If the
Child has received a high school diploma or its equivalent and is not employed,
then the Child must participate in workforce development or other career or
technical education or attend a community college or a university while in the
program.
1. The Child must have a curfew of ……
2. The Child is to have no contact with .....victims/co-
defendants/known gang members......
3. The Child must not use controlled substances.
4. The Child must not possess any firearms.
Other conditions:
…… The child was committed for an offense or attempted offense involving a
firearm and under section 985.433(7)(d), Florida Statutes, the child must
be placed on conditional release for a period of 1 year following release
from a commitment program. Conditional release must include electronic
monitoring of the child by the department for the initial 6 months
following release and at times and under terms and conditions set by the
department.
..... JUVENILE PROBATION: The child is ..... placed continued on..... juvenile
probation under supervision of .....the Department of Juvenile
Justice/.....(name)..... and
..... the court having withheld adjudication of delinquency, for an
indefinite period not to exceed the child’s 19th birthday.
..... the court having adjudicated the child delinquent, for an indefinite
period not to exceed the child’s 19th birthday or the maximum
term of imprisonment an adult could receive for each count listed
above, except for a second degree misdemeanor, six months,
whichever comes first.
..... as part of a sex offender treatment program, for an indefinite
period not to exceed the child’s 21st birthday or the maximum
term of imprisonment an adult could receive for each count listed
above.
..... Disposition on each count is .....concurrent/consecutive ......
..... This case disposition is ..... concurrent with/consecutive to.....case
number ...........
GENERAL CONDITIONS OF JUVENILE PROBATION. The child must abide by
all of the following conditions:
1. The child must obey all laws.
2. The child must be employed full-time or attend school with no
unexcused absences, suspensions, or disciplinary referrals.
3. The child must not change or leave .....his/her.... residence,
school, or place of employment without the consent of .....his/her..... parents
and juvenile probation officer.
4. The child must answer truthfully all questions of .....his/her.....
juvenile probation officer and carry out all instructions of the court and
juvenile probation officer.
5. The child must keep in contact with the juvenile probation officer
in the manner prescribed by the juvenile probation officer.
6. The child must not use or possess alcoholic beverages or controlled
substances.
SPECIAL CONDITIONS OF JUVENILE PROBATION. The child must abide by all
of the conditions marked below:
..... Restitution is ordered.
..... Parent(s) is/are responsible,
..... Child is responsible,
..... jointly and severally with ...........
..... The court reserves jurisdiction to determine the amount of restitution to
be paid.
..... $.......... to be paid to ..... (name) ….. Payments must begin .....(date).....
and continue at the rate of $ .......... each month.
..... Community Service. ..... hours are to be performed by the child at the
rate of ..... hours per month. Written proof is to be provided to the
juvenile probation officer.
..... A letter of apology to be written by the child to .....(name)….. within …..
days. The letter must be a minimum of ..... words.
..... A …… word essay to be written by the child on ..... (subject)…..and
provided to the juvenile probation officer within 30 days.
..... The child must have no ………. contact with victim(s), ..... (name(s)) ......
..... A ..... mental health/substance abuse .....evaluation to be completed by
the child within ….. days. The child will attend and participate in every
scheduled appointment and successfully attend and complete any and
all recommended evaluations and treatment.
..... A curfew is set for the child from .......... p.m. to .......... a.m. Sunday
through Thursday and from .......... p.m. to .......... a.m. Friday and
Saturday.
..... The child must submit to random urinalysis as instructed by the
Department of Juvenile Justice.
..... The child must submit to electronic monitoring by the Department of
Juvenile Justice.
..... The child must successfully complete all special conditions of juvenile
probation ordered in this case on .....(date)......
..... Other: ...........
..... The child must pay court costs of $ .........., as specified below.
The child is placed on notice that the court may modify the conditions of
.....his/her..... juvenile probation at any time and may revoke the juvenile
probation if the court finds there is a violation of the conditions imposed.
DRIVER LICENSE
..... The child’s driver license .....is suspended/is revoked/is
withheld/limitation is extended.....:
..... for .....(months/years)......
..... for a delinquent act involving the use or possession of a firearm,
under section 790.22, Florida Statute.
..... First offense, .....(up to one year)......
..... Second or subsequent offense, .....(up to two years)......
..... for a delinquent act involving the use or possession of a firearm
other than a violation of section 790.22, Florida Statutes, …..(up to
one year)…...
..... for a delinquent act under Chapter 893, Florida Statutes, ..... (up
to six months)......
FIREARM CHARGES
..... Having found the child committed a violation of section 790.22(3),
Florida Statutes, the child is ordered to serve:
..... for a first violation,
.......... days (up to 5), in the Juvenile Detention Center with credit
for .......... days served before disposition and
100 hours of community service or paid work as determined by the
Department.
or
..... for a second or subsequent violation,
.......... days (0 to 21), in the Juvenile Detention Center with credit
for .......... days served before disposition and
.......... hours (not less than 100 nor more than 250) of community
service or paid work as determined by the Department.
..... The court finds that the delinquent act in count .......... involves the use
or possession of a firearm other than a violation of section 790.22(3),
Florida Statutes, and the child is not committed by this order to a
residential commitment program of the Department of Juvenile Justice.
Therefore, under section 985.433(8), Florida Statutes, the child is
ordered to serve:
30 days in secure detention with .......... days credit for time served
before disposition,
100 hours of community service or paid work as determined by the
Department of Juvenile Justice, and
Juvenile Probation under the supervision of the Department of
Juvenile Justice for .......... (a minimum of 1 year).
FINES, FEES, AND COSTS:
..... The child must:
..... pay, notwithstanding the child’s present ability to pay, under
sections 938.27 and 985.032, Florida Statutes,
..... $50.00, per case (in disposition of every misdemeanor case),
the costs of prosecution,
..... $100.00, per case (in disposition of every felony case), the
costs of prosecution, or
..... $.......... to .....(agency)....., which, having claimed costs of
prosecution or investigation, as provided by law, has shown
to a preponderance its entitlement to such costs of
prosecution or investigation;
..... pay $.........., the Crimes Compensation Trust Fund fee, under
section 938.03, Florida Statutes;
..... pay $.........., the Teen Court cost and service charge, under section
938.19, Florida Statutes (if authorized by county ordinance);
..... pay $ .........., the Public Defender application fee, under section
27.52, Florida Statutes;
..... pay, notwithstanding the child’s present ability to pay, the Legal
Assistance Lien for payment of attorneys’ fees or costs, under
section 938.29, Florida Statutes,
..... $50.00, per case (in disposition of every misdemeanor case),
..... $100.00, per case (in disposition of every felony case), or
..... $.........., the court having found sufficient proof of higher
fees and costs incurred to .....(agency).....;
..... pay $.........., other costs, under section(s) .........., Florida Statutes.
..... The child has been adjudicated delinquent and the child must pay
$.........., an additional cost, under section 939.185, Florida Statutes, if
authorized by county ordinance.
..... The child has been adjudicated delinquent and assessed a fine and the
child must pay $.......... to the Crime Prevention Trust Fund, under
section 775.083(2), Florida Statutes.
..... The child has committed an enumerated crime against a minor and the
child must pay $ .........., under section 938.10, Florida Statutes.
..... The child has violated chapter 794, Florida Statutes (sexual battery), or
chapter 800, Florida Statutes, (lewdness; indecent exposure), and is
ordered to make restitution to the Crimes Compensation Trust Fund
under section 960.28(5), Florida Statutes, for the cost of the forensic
physical examination.
..... The child is unable to pay all court costs, and must perform ..........
hours of community service in place of these costs and fees.
SPECIMENS FROM THE CHILD
..... The child has entered a plea of guilty or nolo contendere to, or has been
found by this court to have committed, a delinquent act which is a felony
or an enumerated misdemeanor, and the child must submit specimens
under section 943.325, Florida Statutes.
ORDERS TO PARENTS/GUARDIANS
..... The parent(s) .....is/are.....
..... to complete.....counseling/parenting classes/community
service/restitution.....
..... participate with the child in .....court-imposed sanction/community
work project.....
..... Under section 985.039, Florida Statutes:
..... the parent/legal guardian, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive,
Tallahassee, FL 32399-3100, $5 per day for each day the child is
placed in secure detention or placed on committed status and the
temporary legal custody of the child is placed with the department.
..... the parent/legal guardian, .....(name).....,, must pay to the
Department of Juvenile Justice, 2737 Centerview Drive,
Tallahassee, FL 32399-3100, $1 per day for each day the child is
placed into non-secure detention, on probation, or other
supervision status with the department, or is committed to the
minimum risk nonresidential restrictiveness level commitment.
..... the parent/legal guardian, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive,
Tallahassee, FL 32399-3100, a REDUCED fee of $..... per day for
each day the child is in the custody of or supervised by the
department. This reduced fee is based on the court’s finding:
..... that the parent/legal guardian was the victim of the
delinquent act or violation of law for which the child is
currently before the court and is cooperating in the
investigation of the offense.
..... of indigency or significant financial hardship. The facts
supporting this finding are: ...........
..... The cost of care/supervision fee is WAIVED based on the court’s
finding:
..... that the parent/legal guardian was the victim of the
delinquent act or violation of law for which the child is
currently before the court and is cooperating in the
investigation of the offense.
..... of indigency or significant financial hardship. The facts
supporting this finding are: ...........
..... The parent/guardian, .....(name)....., .....(address)....., is liable for
..........% of the payment. The parent/guardian, .....(name).....,
.....(address)....., is liable for ..........% of the payment.
The parties are advised that an appeal is allowed within 30 days of the
date of this order.
DONE AND ORDERED in ..... (city) ....., .......... County, Florida on
.....(date) ....., at .......... a.m./p.m.
Circuit Judge
Copies to:
FORM 8.948. PETITION FOR REVOCATION OF JUVENILE
PROBATION
PETITION FOR REVOCATION OF
JUVENILE PROBATION
The petitioner represents to the court that ....................,
whose residence and address is .................... was adjudicated a
.................... child and placed on juvenile probation by order of this
court dated ...................., and that the child has violated the
conditions of the juvenile probation in a material respect by:
....................
The petitioner represents further that the parent(s) or
custodian(s) .....is/are.....:
…………………..
…………………….
Mother
Residence
…………………..
…………………….
Father
Residence
…………………..
…………………….
Custodian Residence
WHEREFORE, your petitioner requests that process may issue
to bring the above-named child before this court to be dealt with
according to law.
Date: ....................
Petitioner
FORM 8.949. ORDER FOR HIV TESTING
ORDER FOR HUMAN IMMUNODEFICIENCY
VIRUS (HIV) TESTING
The court having been requested by the .....victim/ victim’s
legal guardian/minor victim’s parent..... for disclosure of the child’s
HIV test results FINDS that:
The child, .....(name)....., .....is alleged by petition for
delinquency to have committed/has been adjudicated delinquent
for..... a sexual offense proscribed in chapter 794 or section
800.004, Florida Statutes, involving the transmission of body fluids
from one person to another.
It is ORDERED AND ADJUDGED that:
1. The child, .....(name)....., shall immediately undergo
Human Immunodeficiency Virus testing.
2. The testing shall be performed under the direction of the
Department of Health in accordance with section 381.004, Florida
Statutes.
3. The results of the test performed on the child pursuant to
this order shall not be admissible in any juvenile proceeding arising
out of the .....alleged sexual offense/sexual offense......
4. The results of the test shall be disclosed, under the
direction of the department, to the child and to the
.....victim/victim’s legal guardian/minor victim’s parent...... The
department shall ensure that the provisions of section 381.004,
Florida Statutes, for personal counseling are available to the party
requesting the test results.
DONE AND ORDERED at ...................., Florida, .....(date)......
Circuit Judge
FORM 8.950. RESTITUTION ORDER
JUDGMENT AND RESTITUTION ORDER
THIS CAUSE was heard on .....(date)....., on the state’s motion
for an order requiring the child, born .....(date)....., or .....his/her.....
parent(s), to pay restitution costs for the benefit of the victim
pursuant to sections 985.0301(5)(i), 985.437, and 775.089, Florida
Statutes.
Name of victim: ....................
Attorney or Advocate: ....................
Address: ....................
The court being fully advised in the premises, it is ORDERED
AND ADJUDGED:
The state’s motion is granted and the .....child/ child’s
parent(s), .....(name(s))....., shall pay restitution for the benefit of the
victim named above as follows:
..... $..... for medical and related services and devices relating to
physical, psychiatric, and psychological care, including nonmedical
care rendered in accordance with a recognized method of healing.
..... $..... for necessary physical and occupational therapy and
rehabilitation.
..... $..... to reimburse the victim for income lost as a result of the
offense.
..... $..... for necessary funeral and related services, if the offense
caused bodily injury resulting in the death of the victim.
..... $..... for damages resulting from the offense.
..... $..... for .....................
The total amount of restitution due is $......
Payment shall be made to the clerk of the circuit court.
Payment schedule:
..... Installment payments of $..... payable on a
.....weekly/monthly..... basis.
..... Payment is due in full.
..... The court finds that the .....child/child’s parent(s).....
.....is/are..... unable to pay and orders the child to perform .....
hours of community service in lieu of .....partial/total.....
restitution.
The court retains jurisdiction over this child beyond
.....his/her..... nineteenth birthday in order to enforce the
provisions of this order and retains jurisdiction to modify the
restitution in this case.
Other, specified conditions: ……….
IT IS FURTHER ORDERED AND ADJUDGED that the clerk of
the court shall provide the victim named above a certified copy of
this order for the victim to record this judgment as a lien, pursuant
to section 55.10, Florida Statutes.
IT IS FURTHER ORDERED AND ADJUDGED that this
judgment may be enforced by the state or the victim in order to
receive restitution in the same manner as a judgment in a civil
action. Execution shall issue for all payments required under this
order.
DONE AND ORDERED AT .....(city)....., .....(county)....., Florida,
on .....(date)......
Circuit Judge
Copies to:
State Attorney
Counsel for Child
Victim
Department of Juvenile Justice
Parent(s)
FORM 8.951. MOTION FOR JUVENILE SEXUAL OFFENDER
PLACEMENT
MOTION FOR JUVENILE SEXUAL
OFFENDER PLACEMENT
Comes now the .....State of Florida, by and through the
undersigned assistant state attorney/Department of Juvenile
Justice, by and through its undersigned counsel....., and moves the
court for Juvenile Sexual Offender placement. In support thereof,
movant would show:
..... that the juvenile has been found by the court, under section
985.35, Florida Statutes, to have committed a violation of chapter
794, chapter 796, chapter 800, section 827.071, or section
847.0133, Florida Statutes; or
..... that the juvenile has been found to have committed any
violation of law or delinquent act involving juvenile sexual abuse as
defined in section 985.475(1), Florida Statutes.
Placement in a juvenile sexual offender program is required for
the protection of the public and would best serve the needs of this
juvenile.
WHEREFORE, as this child meets the juvenile sexual offender
placement criteria, the .....state/ department..... respectfully
requests this court to enter an order placing the child as a juvenile
sexual offender under section 985.48, Florida Statutes.
Date: ....................
Assistant State Attorney/DJJ
Attorney
.....(address & phone no.).....
Florida Bar No.: ..........
FORM 8.952. FINDINGS FOR JUVENILE SEXUAL OFFENDER
REGISTRATION
REQUIRED FINDINGS FOR JUVENILE SEXUAL OFFENDER
REGISTRATION
The following findings are to be made for adjudications of
delinquency made on or after July 1, 2007, for committing, or
attempting, soliciting, or conspiring to commit any of the following
offenses, when the offender is 14 years of age or older at the time of
the offense.
Check the appropriate charge and make the corresponding findings:
Date of the offense: ....................
Offender’s age at date of offense: ....................
Victim’s age at date of offense: ....................
..... F.S. 794.011: Sexual Battery: Oral, anal, or vaginal
penetration by, or union with, the sexual organ of another, or the
anal or vaginal penetration of another by any other object.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense.)
….. F.S. 800.40(4)(b): Lewd or Lascivious Battery: Encouraging,
forcing, or enticing any person less than 16 years of age to
engage in sadomasochistic abuse, sexual bestiality, prostitution, or
any other act involving sexual activity.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense and at least one
of the lines below is checked “Yes.”)
Was the victim under the age of 12 at the time of the offense?
Yes ..... No .....
Did the sexual activity involve force or coercion? Yes ..... No
.....
..... F.S. 800.04(5)(d): Lewd or Lascivious Molestation – Victim
12-15: Intentionally touching the breasts, genitals, genital area,
buttocks, or the clothing covering them, of a person 12 years of
age or older but less than 16 years of age, or forcing or enticing a
person less than 16 years of age to so touch the perpetrator.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense and both boxes
below are checked “Yes.”)
Did the sexual activity involve unclothed genitals? Yes ..... No
......
Did the sexual activity involve force or coercion? Yes ..... No
.....
..... F.S. 800.04(5)(c): Lewd or Lascivious Molestation – Victim
under 12: Intentionally touching the breasts, genitals, genital
area, buttocks, or the clothing covering them, of a person less
than 12 years of age, or forcing or enticing a person less than 12
years of age to so touch the perpetrator.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense and the box
below is checked “Yes.”)
Did the sexual activity involve unclothed genitals? Yes ..... No
......
(Check one only)
SEXUAL OFFENDER REGISTRATION IS REQUIRED ......
SEXUAL OFFENDER REGISTRATION IS NOT REQUIRED ......
DONE AND ORDERED ON .....(date).....
Circuit Judge
FORM 8.953. WAIVER OF RIGHTS
WAIVER OF RIGHTS
1. Right to counsel.
I have the right to have a lawyer help me at all times while I
am in juvenile court. If I cannot afford a lawyer, the court will
appoint one to help me. The person next to me is a lawyer who can
help me.
I have talked to a lawyer about my case.
2. Entering a plea.
This means that I am not fighting the charge(s). It means that
I am entering a plea of guilty or no contest.
By pleading guilty, I am admitting that I did the crime(s) that
the state says I did.
By pleading no contest, I am entering a plea because it is in
my best interest, but I am not admitting that I did anything wrong.
3. Nature of the charge(s) against me.
I know the crime(s) I have been charged with and what they
mean.
I understand what crime(s) I am entering a plea to and which
ones (if any) the state will dismiss.
4. Constitutional Rights
By entering a plea, I am giving up the following constitutional
rights:
(a) Presumption of innocence.
Right now I am considered innocent and the state has to
prove that I am guilty or that I did what they say I did beyond a
reasonable doubt. I do not have to prove that I am innocent.
(b) Right to trial.
The state would try to prove I am guilty at a trial or
adjudicatory hearing. The state may use evidence such as witness
testimony, fingerprints, videos, or photos.
(c) Right to call and cross examine witnesses.
Witness testimony would be people who have information
about the crime that are required to come to the trial. They will
swear to tell the truth and answer questions by the prosecutor and
my lawyer. The state would ask the witnesses questions and my
lawyer and I would also be able to ask the witnesses questions.
I would also have the right to call my own witnesses at
trial to tell my side of the story and speak for me on my behalf.
(d) Right to testify on your own behalf.
I would also have the right to tell the judge my side of the
story after discussion with my lawyer.
(e) Right to remain silent.
I do not have to tell my side of the story. I can sit with
my lawyer and not say anything. My decision to not talk or present
evidence will not affect how the judge decides whether I am guilty or
not guilty.
5. Evidence and/or Defenses.
My lawyer has informed me of the facts that the state would
have to prove before I could be found guilty and has discussed with
me any possible defenses that could be used in my case. I am
entering this plea because I think the state could prove I am guilty
if we went to trial or because it is in my best interest.
6. Consequences of a Plea.
My lawyer, or the court, has informed me of the possible
consequences of entering into this plea, including, but not limited
to:
(a) loss of driver license;
(b) deportation issues;
(c) how this will affect my record and future
punishment from the court, including possible consequences in
adult court;
(d) how this affects my ability to get a job, join the
military, or apply for college;
(e) how this will affect my ability or my parent’s or
guardian’s ability to secure or maintain housing; and
(f) issues relating to sex offender registration and
notification as well as Jimmy Ryce consequences.
7. Voluntary and Intelligent.
I am entering this plea because I want to or because I think it
is in my best interest. No one is forcing me to enter this plea. No
promises or threats have been made to get me to enter this plea.
I am not under the influence of alcohol, drugs, or medications
at this time.
8. Appeal.
If I went to trial and the juvenile court judge decided that I was
guilty, I could ask some other judges, called appellate judges, to
look over the trial and decide if the trial was fair and if the decision
was fair and correct.
This is called my right to appeal. However, if the judge accepts
this plea, the only issues I will be able to appeal are those that
relate to my sentence and to the judge’s authority to hear my case.
I am presently represented by …..(name)…… My lawyer has
gone over all my rights and I am satisfied with the advice and help
of my lawyer.
Child Attorney for child Date
(print name) (print name)
C. DEPENDENCY FORMS
FORM 8.958. ORDER APPOINTING SURROGATE PARENT
ORDER APPOINTING SURROGATE PARENT
FOR DEPENDENT CHILD WHO HAS OR IS
SUSPECTED OF HAVING A DISABILITY
The court finds that:
1. The child has, or is suspected of having, a disability as
defined in the Individuals with Disabilities in Education Act
(“IDEA”) and F.S. 1003.01(3).
2. A surrogate parent is needed to act in the place of a
parent in educational decision-making and in safeguarding the
child’s rights under the IDEA.
3. The child is entitled, under the Individuals with
Disabilities in Education Act (“IDEA”), 20 U.S.C. §1415(b)(2); 34
C.F.R. §§300.515 and 303.406; F.S. 39.0016(3)-(4), 39.4085(17);
and Fla. Admin. Code 6A-6.0333, to the assistance of a surrogate
parent be-cause (check all that apply):
..... Parental rights have been terminated
..... Parents cannot be located
..... No parent is available to make education decisions
related to the child’s disability
..... Foster parent is unwilling or unable to make educational
decisions related to the child’s disability
..... Child resides in a group home or therapeutic foster home
..... Other: ....................
ACCORDINGLY, it is ORDERED that:
1. .....(Name)..... is appointed as a surrogate parent for
.....(child’s name)......
2. The surrogate parent named above has the following
rights, duties, and responsibilities:
a. to request or respond to requests for evaluations of
the child;
b. to review and keep confidential the child’s
educational records;
c. to request and participate in school meetings including
Individual Education Plan (IEP) meetings;
d. to express approval or disapproval of a child’s
educational placement or IEP;
e. to monitor the child’s educational development;
f. to help the child access available and needed
educational services;
g. to aid the child in securing all rights provided the
child under the IDEA;
h. to meet the child face-to-face
i. to be afforded all of the due process rights parents
hold under the IDEA
3. The surrogate parent may also do the following: (check all
that apply)
..... attend appropriate court hearings to address the
educational needs of the child. The surrogate parent will be
provided notice of all dependency court hearings.
..... attend dependency staffings. The community-based care
provider will invite the surrogate parent to all permanency staffings
and any other staffings when the child’s educational needs will be
addressed. See F.A.C. 65C-28.006.
..... ....................
..... ....................
4. As to issues affecting the provision of a Free Appropriate
Public Education, principals, teachers, administrators, and other
employees of the .......... County Public Schools shall communicate
with the surrogate parent and accept the requests or decisions of
the surrogate parent in the same manner as if he or she were the
child’s parent.
5. Unless the court explicitly orders otherwise, the
surrogate parent does not have the right and responsibility to
register the child in school, and grant or withhold consent for
ordinary school decisions not related to IDEA (such as field trips,
sports and club activities, medical care, etc.).
6. The surrogate parent must have access to and keep
confidential the child’s records including, but not limited to, records
from the school system, community-based care provider or agency,
and any mental health or medical evaluations or assessments.
7. By law, the surrogate parent has no liability for actions
taken in good faith on behalf of the child in protecting the special
education rights of the child.
ORDERED on .....(date)....., in .........., .......... County, Florida.
Circuit Judge
Copies to:
County Public Schools c/o Director, Exceptional Student
Education, Surrogate parent named above
(Check all that apply)
..... Attorney for DCF: .....(name).....
..... DCF caseworker: .....(name).....
..... Guardian ad Litem: ....(name).....
..... Attorney for mother: .....(name).....
..... Attorney for father: .....(name).....
..... Attorney for child: .....(name).....
..... Child named above .....(name).....
..... Foster parent: .....(name).....
..... Relative caregiver: .....(name).....
..... Child’s principal: .....(name)..... at ................... School
..... Other: ....................
..... Other: ....................
FORM 8.959. SUMMONS FOR DEPENDENCY ARRAIGNMENT
SUMMONS AND NOTICE OF HEARING
STATE OF FLORIDA
TO: .....(name and address of person being summoned).....
.....(Petitioner’s name)..... has filed in this court a
petition, alleging under oath that the above-named child(ren) is/are
dependent under the laws of the State of Florida and requesting
that a summons issue in due course requiring that you appear
before this court to be dealt with according to law. A copy of the
petition is attached to this summons.
You are to appear before this Court at .....(location of
hearing)....., at .....(time and date of hearing)......
FAILURE TO APPEAR AT THE ARRAIGNMENT HEARING
CONSTITUTES CONSENT TO THE ADJUDICATION OF THIS
CHILD (OR CHILDREN) AS A DEPENDENT CHILD (OR
CHILDREN) AND MAY ULTIMATELY RESULT IN LOSS OF
CUSTODY OF THIS CHILD (OR CHILDREN).
IF YOU FAIL TO APPEAR YOU MAY BE HELD IN CONTEMPT OF
COURT.
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 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.
Witness my hand and seal of this court at .....(city, county,
and state)....., on .....(date)......
CLERK OF COURT
BY:
DEPUTY CLERK
CITATORIO Y AVISO DE AUDIENCIA
ESTADO DE FLORIDA
PARA: ..... (nombre y dirección de la persona citada).....
..... (Nombre del peticionario)..... ha presentado en este
tribunal una petición, alegando bajo juramento que los niños
mencionados anteriormente son dependientes según las leyes del
Estado de Florida y solicitando que se emita un citatorio a su
debido tiempo que requiera que comparezca ante este tribunal para
ser tratado de acuerdo con la ley. Se adjunta copia de la petición a
este citatorio.
Deberá comparecer ante este Tribunal en ..... (lugar de la
audiencia)....., en ..... (hora y fecha de la audiencia)......
NO COMPARECER EN LA AUDIENCIA DE TUTELA CONSTITUYE
UN CONSENTIMIENTO PARA LA ADJUDICACIÓN DE ESTE NIÑO
(O NIÑOS) COMO HIJO (O HIJOS) DEPENDIENTE(S) Y, EN
ÚLTIMA INSTANCIA, PUEDE RESULTAR EN LA PÉRDIDA DE LA
CUSTODIA DE ESTE NIÑO (O NIÑOS).
SI NO SE PRESENTA, PUEDE SER DECLARADO EN DESACATO AL
TRIBUNAL.
COMENTARIO: El siguiente párrafo debe estar en negrita, 14 pt.
fuente Times New Roman o Courier.
Si usted es una persona con una discapacidad que necesita
alguna adaptación para participar en este procedimiento, tiene
derecho, sin costo alguno para usted, a que se le provea de
cierta asistencia. Póngase en contacto con ..... (nombre,
dirección, número de teléfono)..... al menos 7 días antes de su
comparecencia programada ante el tribunal, o inmediatamente
después de recibir esta notificación si el tiempo antes de la
comparecencia programada es inferior a 7 días. Si tiene
problemas de audición o de voz, llame al 711.
Doy fe con mi firma y sello de este tribunal en..... (ciudad, condado
y estado)....., en ..... (fecha)......
SECRETARIO DEL TRIBUNAL
POR: _________________________
SECRETARIO ADJUNTO
MANDA AK AVÈTISMAN POU YON CHITA TANDE
LETA FLORID
POU: ....(non ak adrès pou moun yo voye manda-a)......
kÒm, tantiske, .....(non pati ki fé demann-nan).... fé yon
demann devan tribinal-la, epi li sèmante timoun-nan(yo), swa dizan
bezwen pwoteksyon leta dapre règ lalwa nan Leta Florid, yon kopi
enfòmasyon sou akizasyon-an kwoke nan lèt sa-a. Yo mande pou yo
sèvi-w ak yon manda touswit, ki pou fose-w prezante devan tribinal
la pou yo ka koresponn avèk ou, dapre lalwa.
Alò, pou sa yo kòmande-w pou prezante devan tribinal sa-a, ki
nan ....., (adrès tribinal-la) ......, a .... (nan dat ak lè, chita tande-a)
.....
SI OU PA PREZANTE NAN CHITA TANDE-A, POU YO KA AVÈTI-
W AK AKIZASYON OFISYÈL-LA, SA KA LAKÒZ YO DESIDE OU
KON-SANTI TIMOUN-NAN(YO), BEZWEN PWOTEKSYON LETA,
EPI LI KA LAKÒZ OU PÈDI DWA-OU KÒM PARAN TIMOUN SA-
A(YO).
SI OU PA PREZANTE, YO GEN DWA CHAJE-W, KÒMKWA OU
MANKE TRIBINAL LA DEGA.
Si ou se yon moun infirm, ki beswen `ed ou ki bewsen ke o
akomode w pou ou patispe nan pwosedi sa yo, ou genyen dwa,
san ke ou pa peye, a setin `ed. Silvouple kontake …..(non,
address, telephone)….. o moin 7 jou avan dat ou genyen
rendevou pou ale nan tribunal, ou si le ou resevwa avi a, genyen
mouins ke 7 jou avan date endevou tribunal la. Ou si ou pa
tande pale, rele nan nimerro sa 711.
Mwen siyen non mwen, epi mete so mwen, nan dokiman
tribinal-la sa-a, kòm temwen, nan (vil, distrik, eta) ...., nan ....
(dat).....
GREFYE TRIBINAL-LA
PA:
ASISTAN GREFYE TRIBINAL-LA
FORM 8.960 SHELTER PETITION
AFFIDAVIT AND PETITION FOR PLACEMENT IN SHELTER
COMES NOW, the undersigned, who being first duly sworn
says:
1. On .....(date)..... at .......... a.m./p.m. the above named
minor child(ren) was/were found within the jurisdiction of this
court.
..... The child(ren) was/were taken into custody by ...........
..... The child(ren) need(s) to be taken into protective custody.
2. The name, age, special needs, and residence of this/these
child(ren) is/are:
Birth Special
Name date Sex Needs Address
....................... ................... ................ .......................
.......................
....................... ................... ................ .......................
.......................
....................... ................... ................ .......................
.......................
3. The name, relationship to the child(ren), and address of
the child(ren)’s parents or other legal custodian(s) is/are:
Name Relationship Address
..................... ..................... .....................
..................... ..................... .....................
4. The following individuals who were listed in #3 above
have been notified in the following manner of the date, time, and
location of this hearing:
Name Manner Notified
…………………………………
………………………………….
…………………………………
………………………………….
…………………………………
………………………………….
5. There is probable cause that the child(ren)
..... a. has/have been abused, abandoned, or neglected ort
is/are in imminent danger of illness or injury as a result of abuse,
abandonment, or neglect;
..... b. was/were with a parent or legal custodian who has
materially violated a condition of placement imposed by the court;
..... c. has/have no legal custodian, or responsible adult relative
immediately known and available to provide supervision and care;
because ...........
6. The provision of appropriate and available services will
not eliminate the need for placement of the child(ren) in shelter care
because:
..... a. an emergency existed in which the child(ren) could not
safely remain in the home;
..... b. the home situation presents a substantial and immediate
danger to the child(ren) which cannot be mitigated by the provision
of preventive services;
..... c. the child(ren) could not be protected in the home despite
the provision of the following services and efforts made by the
Department of Children and Families to prevent or eliminate the
need for placement in shelter care;
..... d. the child(ren) cannot safely remain at home because
there are no preventive services that can ensure the safety of the
children.
7. The department has made reasonable efforts to keep the
siblings together after the removal from the home. The reasonable
efforts of the department were ..........
..... a. The children are currently placed together ...........
..... b. A foster home is not available to place the siblings
together because ...........
..... c. It is not in the best interest of each child that all the
siblings be placed together in out-of-home care because ...........
8. On-going visitation or interaction between the siblings
.....(list)..... is
..... a. recommended as follows ...........
..... b. not recommended because visitation or interaction would
be contrary to the safety or well-being of .....(name(s))..... because
...........
9. The child(ren) is/are in need of and the petitioner
requests the appointment of a guardian ad litem.
10. The petitioner requests that the parents, if able, be
ordered to pay fees for the care, support, and maintenance of the
child(ren) as established by the department under chapter 39,
Florida Statutes.
11. The petitioner requests that the parents be ordered to
provide to the Department of Children and Families and the
Department of Revenue financial information necessary to
accurately calculate child support under section 61.30, Florida
Statutes, within 28 days of this order.
12. This affidavit and petition is filed in good faith and under
oath.
WHEREFORE, the affiant requests that this court order that
this/these child(ren) be placed in the custody of the department
until further order of this court and that the place of such custody
shall be:
..... at the discretion of the Department of Children and Families;
..... at the home of a responsible adult relative, .....(name).....,
whose address is ...............;
..... other.
Moving Party
.....(attorney’s name).....
.....(address and telephone
number).....
E-mail address: ..........
Florida Bar number: ..........
Verification
NOTICE TO PARENTS/GUARDIANS/LEGAL CUSTODIANS
A date and time for an arraignment hearing is normally set at
this shelter hearing. If one is not set or if there are questions, you
should contact the Juvenile Court Clerk’s Office at ........... A copy of
the Petition for Dependency will be given to you or to your attorney,
if you have one. A copy will also be available in the clerk’s office.
You have a right to have an attorney represent you at this hearing
and during the dependency proceedings and an attorney will be
appointed for you if you request an attorney and the court finds
that you are unable to afford an attorney.
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 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.
FORM 8.961. SHELTER ORDER
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
FORM 8.961(A). ORDER AUTHORIZING ACCESS TO CHILD’S
MEDICAL AND EDUCATIONAL RECORDS
ORDER AUTHORIZING ACCESS TO CHILD’S MEDICAL
AND EDUCATIONAL RECORDS
THIS CAUSE came on to be heard under sec. 39.402, Florida
Statutes, concerning access to the medical and educational records
of ...................., a child.
The Court finds
A. As to medical records and information:
..... ...................., mother/father of ..................., the child,
consents to the entry of this order, and to the court’s providing
access to the child’s medical records to the department, its contract
agencies, and any guardian ad litem and attorney for the child, and
to provide the child’s medical information to the court.
..... No parent or legal guardian of the child is available or
able to consent to the entry of this order, or the parents withhold
consent to providing access to the child’s medical records and/or to
providing the requested medical information.
..... Access to the child’s medical records and information is
necessary to provide services to the child.
B. As to educational records and information.
..... ...................., mother/father of ...................., the child,
consents to the entry of this order, and to the court’s providing
access to the child’s educational records to the department, its
contract agencies, and any guardian ad litem and attorney for the
child, and to provide the child’s educational information to the
court.
..... No parent or legal guardian of the child is available or
able to consent to the entry of this order, or the parents withhold
consent to providing access to the child’s educational records
and/or to providing the requested educational information.
..... Access to the child educational records and information
is necessary to provide services to the child.
Therefore, it is ORDERED
The department, .....(name of CBC)....., its contract agencies,
.....(name)....., guardian ad litem, and .....(name)....., attorney for
child, are authorized to access .....(child’s name).....’s medical and
educational records and information, until further order of this
court.
..... This order does not address the child’s privacy rights to
any of these records or information that may exist under Florida
law. The child may assert to this court any objection under privacy
rights to the release of this information
ORDERED on .....(date)....., in .........., .......... County, Florida
Circuit Judge
Copies to:
(Check all that apply)
..... Attorney for DCF: .....(name).....
..... Caseworker: .....(name).....
..... Guardian ad litem: .....(name).....
..... Attorney for mother: .....(name).....
..... Attorney for father: .....(name).....
..... Attorney ad litem for child: .....(name).....
..... Child named above: .....(name).....
..... Other: ....................
..... Other: ....................
FORM 8.964. DEPENDENCY PETITION
PETITION FOR DEPENDENCY
COMES NOW, Petitioner, .....(name)....., by and through
undersigned counsel, and petitions this court to adjudicate the
above-named minor child(ren) to be dependent within the meaning
and intent of chapter 39, Florida Statutes. As grounds, petitioner
alleges the following:
1. This court has jurisdiction over the minor child(ren),
.....(name(s))....., a .....(gender)..... child, whose date(s) of birth is/are
.........., and who, at the time the dependency arose, was/were in
the custody of .....(name(s))......
2. The natural mother of the minor child(ren) is
.....(name)....., a resident of .....(state)....., whose address is ………..
3. The father of the minor child(ren), .....(name(s))..... is
.....(name)....., whose address is ……….. The father ..... is ..... is not
married to the mother, and ..... is ..... is not listed on the child(ren)’s
birth certificate(s). The mother filed a Sworn Statement About
Identity or Location of Father with this court on .....(date)....., which
named ………. as the father.
4. The UCCJEA Affidavit ..... is attached ..... was filed with
the Court on .....(date)..... and is incorporated by reference.
5. The child(ren) is/are dependent within the meaning and
intent of chapter 39, Florida Statutes, in that the
mother/father/parents/legal custodian/caregiver(s) abused,
abandoned, or neglected the minor child(ren) on or about
.....(date)....., by: .................... and that these activities and
environments cause the child(ren)’s physical, mental, or emotional
health to be in danger of being significantly impaired.
OR
5. The above named child(ren) is/are presently under
substantial risk or imminent threat of harm or abuse or neglect,
within the meaning and intent of chapter 39, Florida Statutes,
which is likely to cause the child(ren)’s physical health to be
significantly impaired because .....................
6. The department is unable to ensure the protection of the
minor child(ren) without judicial intervention.
7. The mother/father/parents has/have received the
following services: .....................
8. A shelter hearing was held on .....(date)....., and the
child(ren) was/were placed in the custody of .....................
9. An arraignment hearing
..... needs to be scheduled.
..... is scheduled for .....(date and time)......
10. A guardian ad litem
..... needs to be appointed.
..... was appointed at the shelter hearing to represent
the child(ren).
11. .....(name of child(ren))..... has/have special needs as
defined in Chapter 39, Florida Statutes. An attorney:
..... needs to be appointed.
..... has been appointed.
12. Under chapter 39, Florida Statutes, the clerk of the court
is required to issue a summons to the following parents or
custodians:
The natural mother, .....(name)....., whose address is
.....................
The natural father, .....(name)....., whose address is
.....................
.....(Additional fathers and their addresses)......
WHEREFORE, the petitioner asks that process may issue in
due course to bring the above-named parties before the court to be
dealt with according to the law, to adjudicate the named minor
child(ren) named to be dependent.
….(Petitioner’s name)……
…… (Attorney’s name)…..
….. (address and telephone number)
Florida Bar Number:……….
Verification
Certificate of service
NOTICE OF RIGHTS
PLEASE READ THIS PETITION BEFORE ENTERING THE
COURTROOM.
YOU HAVE A RIGHT TO HAVE COUNSEL PRESENT AT THIS
HEARING.
BY COPY OF THIS PETITION, THE PARENTS, CAREGIVERS,
AND/OR LEGAL CUSTODIANS ARE NOTIFIED OF THEIR RIGHT
TO HAVE LEGAL COUNSEL PRESENT FOR ANY PROCEEDING
RESULTING FROM THIS PETITION OR TO REQUEST THE
COURT TO HAVE COUNSEL APPOINTED, IF INDIGENT.
Further, these persons are informed of the following:
An arraignment is set on this matter for .....(date)....., at
..... a.m./p.m., at .....(location)...... The purpose of the
arraignment is to advise as to the allegations contained in the
Petition For Dependency. When your case is called, the Judge
will ask you to enter a plea to this petition. The plea entered
may be one of the following:
1. Admit: This means you admit that the petition states
the truth and you do not want a trial.
2. Consent: This means you neither admit nor deny the
petition, but do not want a trial.
(If you enter either of the above two pleas, the court will
set a disposition date for the matter. At disposition, the court
will decide where the child will stay and under what
conditions).
3. Deny: This means you deny the allegations of the
petition and wish the state to attempt to prove them at a trial.
4. Continue: This means you wish time to confer with
an attorney, before entering a plea. If you enter this plea, the
court will schedule another hearing in approximately 2 weeks.
At that time, another arraignment hearing will be held, and you
(or your attorney) must enter one of the above three pleas.
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, and 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.
FORM 8.965. ARRAIGNMENT ORDER
ORDER ON ARRAIGNMENT AND
NOTICE OF NEXT HEARING
THIS CAUSE came to be heard on .....(date)....., under chapter
39, Florida Statutes, on the Petition For Dependency filed by
.....(name)....., for arraignment of .....(name(s))...... The following
persons appeared before the Court:
….. ….. (Name)….., Petitioner
….. ….. (Name)….., Attorney for the petitioner
….. ….. (Name)….., Attorney for the department
….. ….. (Name)….., Department caseworker
….. ….. (Name)….., Mother
….. ….. (Name)….., Attorney for the mother
….. ….. (Name)….., Father of …..(child)…..
….. ….. (Name)….., Attorney for father
….. ….. (Name)….., Guardian ad litem
….. ….. (Name)….., Attorney for guardian ad litem
….. ….. (Name)….., Attorney/Attorneys for …..Child/Children…..
….. ….. (Name)….., Legal custodian
….. ….. (Name)….., Attorney for legal custodian
….. ….. (Name)….., 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.
The court having considered the Petition for Dependency and
having heard testimony and argument, and having been otherwise
duly advised in the premises finds:
1. This court has jurisdiction over the subject matter of this
action; and
2. The mother, …… (name)…..:
….. was …..not noticed of this hearing
…..did not appear, and the court:
….. entered a consent by default
…… did not enter a consent by default;
….. appeared with counsel….. appeared without counsel and:
….. was….. was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily, …..waived
……did not waive her right to legal counsel; and
……was ….. was not determined to qualify as indigent
and….. was ….. was not appointed an attorney.
..... was served with a petition for dependency, and entered a
plea of: ..... Admit, ..... Deny, ..... Consent, ..... No Plea,
..... Continuance
..... The Petitioner:
….. will continue a diligent search and will attempt service.
..... has conducted an adequate diligent search and is excused
from further diligent search and further attempts at service.
3. The father, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a consent by default
..... did not enter a consent by default;
….. appeared with counsel….. appeared without counsel and:
….. was….. was not advised of his right to legal counsel;
….. knowingly, intelligently, and voluntarily, …..waived
……did not waive his right to legal counsel; and
……was ….. was not determined to qualify as indigent
and….. was ….. was not appointed an attorney......
was served with a petition for dependency, and entered a plea of:
..... Admit, ..... Deny, ..... Consent, ..... No Plea, ..... Continuance
..... The Petitioner:
..... will continue a diligent search and will attempt service.
..... has conducted an adequate diligent search and is excused
from further diligent search and further attempts at service.
4. That the child(ren)’s current placement in shelter care:
..... is no longer appropriate, and the child(ren) shall be
returned to ……….
..... is appropriate, in that the child(ren) is/are in a setting
which is as family-like as possible, consistent with the
child(ren)’s best interest and special needs; and, that returning
the child(ren) to the home would be contrary to the best interest
of the minor child(ren); and, that every reasonable effort has
been made to eliminate the need for placement of the child(ren)
in shelter care, but present circumstances of the child(ren) and
the family are such that shelter care is the only way to ensure
the child(ren)’s health, safety, and well-being.
5. Additional findings: ……….
THEREFORE, based on the foregoing findings of fact, it is
hereby ORDERED and ADJUDGED that:
1. The minor child(ren) shall:
..... be ..... returned to ..... remain in the care and custody of
.....(name)......
..... remain in the care and custody of the department in
shelter care pending adjudication and disposition or until further
order of this court.
2. The child(ren): ..... is/are ..... is/are not adjudicated
dependent at this hearing.
3. ..... Mediation ..... A case planning conference is/are
ordered at this time and shall be conducted on .....(date)......, at
.......... a.m./p.m., at .....(location)...... All parties, unless otherwise
specified, shall attend.
4. As to the mother, .....(name)....., the court:
Accepts the plea of: ..... Admit, ..... Deny, ..... Consent, .....
Continuance.
.....Appoints ..... Does not appoint an attorney.
Sets a hearing for ..... re-arraignment ...... adjudicatory trial
..... disposition and case plan hearing ..... trial status on
.....(date)..... at ..... a.m./p.m.
5. As to the father, .....(name)....., the court:
Accepts the plea of: ..... Admit, ..... Deny, ..... Consent, .....
Continuance.
..... Appoints ..... Does not appoint an attorney.
Sets a hearing for ..... re-arraignment ...... adjudicatory trial
..... disposition and case plan hearing ..... trial status on
.....(date)..... at ..... a.m./p.m.
6. All prior orders not inconsistent with the present order
shall remain in full force and effect.
DONE AND ORDERED on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)..... or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.966. ADJUDICATION ORDER — DEPENDENCY
ORDER OF ADJUDICATION
THIS CAUSE came before this court on .....(date)....., under
chapter 39, Florida Statutes, for adjudication of the Petition for
Dependency filed by .....(petitioner’s name)....... Present before the
court were:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name(s))....., Minor child(ren)
..... .....(Name)....., Attorney ad litem for minor child(ren)
..... .....(Name)....., 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.
The court having heard testimony and argument and being
otherwise fully advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings, is/are dependent within the meaning and
intent of chapter 39, Florida Statutes, and is/are (a) resident(s) of
the State of Florida.
2. The mother, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of her right to legal counsel,
..... knowingly, intelligently, and voluntarily ..... waived .....
did not waive her right to legal counsel and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
3. The father, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of her right to legal counsel,
..... knowingly, intelligently, and voluntarily ..... waived .....
did not waive her right to legal counsel and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
……4. That the child(ren) is/are dependent within the
meaning and intent of chapter 39, Florida Statutes, in that the
mother, ....(name)....., abused, neglected, or abandoned the minor
child(ren) by ................................. These facts were proven by .....
preponderance of the evidence ...... clear and convincing evidence.
……5. That the child(ren) is/are dependent within the
meaning and intent of chapter 39, Florida Statutes, in that the
father, .....(name)....., abused, neglected, or abandoned the minor
child(ren) by ............................... These facts were proven by .....
preponderance of the evidence ...... clear and convincing evidence.
COMMENT: Use 6, 7, and 8 only if the child is in out-of-home
placement.
6. That the Court finds that it is in the best interest of the
child(ren) to remain in out-of-home care.
7. That every reasonable effort was made to eliminate the
need for placement of the child(ren) in out-of-home care but the
present circumstances of the child(ren) and the ..... mother .....
father are such that out-of-home care is the only way to ensure the
health, safety, and well being of the child(ren), in that
..............................
8. That the child(ren)’s placement in .....(type of
placement)..... is in a setting which is as family like and as close to
the home as possible, consistent with the child(ren)’s best interests
and special needs.
9. That returning the minor child(ren) to the custody of
.....(person who had previous legal custody)..... would be contrary to
the best interest and welfare of the minor child(ren).
10. The Court informed any parents present that the parent
or parents shall provide the court and all parties with identification
and location information for such relatives.
THEREFORE, based upon the foregoing findings, it is
ORDERED AND ADJUDGED that:
1. The minor child(ren), ......(name(s))....., is/are adjudicated
dependent.
2. The child(ren) shall remain in the care and custody of
..... the department in shelter care
..... other .....(name).....
pending disposition.
3. The parents shall provide to the Court and all parties
identification and location information regarding potential relative
placements.
4. 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.
5. This court shall retain jurisdiction over this cause to
enter any such further orders that may be deemed necessary for the
best interest and welfare of the minor child(ren).
6. All prior orders not inconsistent with the present order
shall remain in full force and effect.
7. Disposition is scheduled for .....(date)....., at ......
a.m./p.m.
DONE AND ORDERED on .....date..... at .....(city)....., Florida.
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above styled cause on .....(date)..... at .....a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.967. ORDER OF DISPOSITION, ACCEPTANCE OF
CASE PLAN, AND NOTICE OF HEARING
ORDER OF DISPOSITION, ACCEPTANCE OF CASE PLAN,
AND NOTICE OF HEARING
THIS CAUSE came before this court on .....(date)....., under
chapter 39, Florida Statutes, for disposition of the Petition for
Dependency and acceptance of the Case Plan filed by the
Department of Children and Family Services.
The following persons appeared before the court:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other ..........
The court having considered the family functioning
assessment and Case Plan filed by the department and having
heard testimony and argument and being otherwise fully advised in
the premises finds that:
1. The minor child(ren) who is/are the subject matter of
these proceedings, was/were adjudicated dependent within the
meaning and intent of chapter 39, Florida Statutes, continue to be
dependent, and is/are residents of the State of Florida.
2. The minor child(ren) is/are of an age subject to the
jurisdiction of this Court.
3. The following parties were notified of this hearing and
provided a copy of the Case Plan and family functioning assessment
filed in this cause:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Other ..........
4. The mother, .....(name).....:
..... did not appear and ..... was .... was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of her right to legal counsel;
..... knowingly, intelligently, and voluntarily ..... waived
..... did not waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent
and ..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was .....was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of his right to legal counsel;
..... knowingly, intelligently, and voluntarily ..... waived
..... did not waive his right to legal counsel; and
..... was ..... was not determined to qualify as indigent
and ..... was ..... was not appointed an attorney.
6. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of persons notified)......
7. The department filed a family functioning assessment
with the court on .....(date)...... This family functioning assessment
..... is ..... is not in compliance with the statutory requirements.
8. The department filed a case plan with the court on
.....(date)......
a. The terms of the case plan ..... are ..... are not
consistent with the requirements of the law and previous orders of
this court.
b. The case plan ..... is ..... is not meaningful and
designed to address the facts and circumstances on which the court
based the finding of dependency.
c. The case plan ..... is ..... is not in the best interest of
the minor child(ren).
d. The case plan’s stated goal of .......... ..... is ..... is
not a reasonable goal.
e. The parents ..... have ..... do not have the ability to
comply with the terms of the case plan.
9. There is a need for temporary child support from
.....(noncustodial parent(s))..... and that he/she/they ..... has/have
..... do/does not have the ability to pay child support.
COMMENT: Use 10, 11 & 12 if child(ren) is/are not placed in the
home of a parent.
10. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)......
11. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
12. Return of the minor child(ren) to the custody of
.....(person from whom child(ren) was/were originally removed)....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely ..... remain ..... return home
with services and removal of the child(ren) is necessary to protect
the child(ren), in that ………..
13. Prevention or reunification services ..... were not ..... were
indicated and are as listed: ......(services indicated)...... Further
efforts could not have shortened separation of this family because:
………..
COMMENT: Use 14 if the goal of the case plan is reunification.
14. Reasonable efforts to prevent or eliminate the need for
removal of the child(ren) have been made by the department, which
provided the following services: ……….
COMMENT: Use 15 if child(ren) remain(s) or is/are returned to the
parent(s).
…..15. The child(ren) can safely ..... remain with ..... be
returned to ..... (parent(s)’s name(s))..... as long as he/she/they
comply(ies) with the following: ……….
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
……1. The minor child(ren), .....(name(s))..... be placed in
the custody of .....(name)....., under supervision of the department.
2. The family functioning assessment report filed by the
department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
..... accepted by the court with the following
amendments: ………..
3. The case plan filed by the department is:
..... not accepted and a continuance is granted for 30
days or less.
..... accepted by the court.
..... accepted by the court with the following
amendments: ……….
4. All parties are ordered to comply with the provisions of
the case plan and any amendments made to it.
COMMENT: Use 5, 6 & 7 if child(ren) is/are placed outside the
home.
…… 5. The mother, .....(name)....., shall pay child support
in the amount of $........... by the .....(day)..... of each month to
.....(where money is to be paid)....., beginning on .....(date)..... and
continuing until such time as payments begin to be deducted by
income deduction order. All child support payments shall be paid to
the Clerk of the Circuit Court designated to receive child support
payments.
…… 6. The father, .....(name)....., shall pay child support in
the amount of $........... by the .....(day)..... of each month to
.....(where money is to be paid)......, beginning on .....(date)..... and
continuing until such time as payments begin to be deducted by
income deduction order. All child support payments shall be paid to
the Clerk of the Circuit Court designated to receive child support
payments.
…… 7. The legal custodian shall have the right to authorize
for the child(ren) any emergency medical treatment and any
ordinary and necessary medical and dental examinations and
treatment, including blood testing, preventive care including
ordinary immunizations, tuberculin testing, and well-child care, but
not including nonemergency surgery, general anesthesia, provision
of psychotropic medications, or other extraordinary procedures for
which a separate order or informed consent as provided by law is
required.
8. Other: ………..
9. All prior orders not inconsistent with the present order
shall remain in full force and effect.
10. This court shall retain jurisdiction over this cause to
enter any such further orders that may be deemed necessary for the
best interest and welfare of the minor child(ren).
11. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in ...................., Florida, on
.....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at ..... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.968. AFFIDAVIT OF DILIGENT SEARCH
AFFIDAVIT OF DILIGENT SEARCH
STATE OF FLORIDA
COUNTY OF ..........
BEFORE ME, the undersigned authority, personally appeared
.....(name)....., affiant, who, being first duly sworn, deposes and says
that .....he/she..... made a diligent search and inquiry to determine
the residence of .....(name)....., the .....parent/prospective parent.....
of .....(name(s) of child(ren))....., and the results are as follows:
1. Affiant has received the name of the
.....(parent/prospective parent)..... from .....(name)......
2. Affiant has had no face-to-face contact with .....(name of
parent/prospective parent)......
3. On .....(date)..... affiant telephoned information at
.....(name)..... and was informed that there was no listing for
.....(name of parent/prospective parent)......
4. On .....(date)..... affiant searched the .....(city).....
telephone directory and was unable to locate a listing for .....(name
of parent/prospective parent)......
5. On .....(date)..... affiant sent a certified letter, return
receipt requested, to .....(address)....., a last known address of
.....(name of parent/prospective parent)...... On .....(date)..... affiant
received the unclaimed receipt by return mail.
6. On .....(date)..... affiant visited .....(address)....., the last
known address of .....(name of parent/prospective parent)....., and
was informed by .....(name)..... that .....(name of parent/prospective
parent)..... no longer resides there.
7. Affiant has made inquiries of all relatives of .....(name of
parent/prospective parent)..... of the child, including the other
parent, made known to me by the petitioner and .....(name)...... The
names, addresses, and telephone numbers of those relatives
contacted are: .......... None of the relatives contacted know the
current residence or whereabouts of .....(name of
parent/prospective parent)......
8. Affiant has made inquiries of all offices of program areas,
including but not limited to mental health, of the Department of
Children and Family Services likely to have information about
.....(name of parent/prospective parent)...... The names, addresses,
and/or telephone numbers of those offices are: .......... No one in
any of these offices knows the current residence or address of
.....(name of parent/prospective parent)......
9. Affiant has made inquiries of other state and federal
agencies likely to have information about .....(name of
parent/prospective parent)...... The names, addresses, and/or
telephone numbers of those agencies: ........... No one in any of these
agencies knows the current residence or whereabouts of .....(name
of parent/prospective parent)......
10. Affiant has made inquiries of appropriate utility and
postal providers. The names, addresses, and/or telephone numbers
of those providers are: ........... None of those providers know the
current residence or whereabouts of .....(name of
parent/prospective parent)......
11. Affiant has made inquiries of appropriate law
enforcement agencies. The names, addresses, and/or telephone
numbers of those agencies are: ........... .....(Name of
parent/prospective parent)..... is not known to any of these
agencies.
12. Affiant has made inquiries of the federal armed services,
including the United States Army, Navy, Air Force, Marine Corps,
and National Guard. .....(Name of parent/prospective parent)..... is
not currently a member of these services.
13. Affiant has made inquiries of all the hospitals in the
.......... area. The names, addresses, and/or telephone numbers of
those hospitals are: ........... .....(Name of parent/prospective
parent)..... is not currently a patient at, nor has .....he/she.....
recently been admitted to, these hospitals.
14. Affiant has conducted a thorough search of at least one
electronic database specifically designed for locating persons
including .....(name of database)...... No information regarding
.....(name of parent/prospective parent)..... was found in this
electronic database.
15. .....(Name of parent/prospective parent)..... .....is/is
not..... over 18 years of age.
16. Affiant is unable to determine the residence or
whereabouts of .....(name of parent/prospective parent)..... and thus
cannot personally serve process upon .....him/her......
Affiant
Before me, the undersigned authority, personally appeared
.....(name)....., the petitioner in this action, who .....is personally
known to me/produced .....(document)..... as identification....., and
who affirms that the allegations are filed in good faith and are true
and correct to the best of petitioner’s knowledge.
SWORN TO AND SUBSCRIBED before me .....(date)......
NOTARY PUBLIC
Name:……….
Commission No.:…………
My commission expires: …….
OR
Verification (see Form 8.902).
FORM 8.969. SWORN STATEMENT REGARDING IDENTITY OR
LOCATION OF FATHER
SWORN STATEMENT REGARDING
IDENTITY OR LOCATION OF FATHER
1. My name is: …………………………………………..
My address is: ………………………………………...
2. I am related to .....(child’s name)..... because I am his/her
....................
3. I understand that I am answering these questions under
oath and from my own personal knowledge and I swear to tell the
truth. I understand that this sworn statement will be filed with the
court.
4. The mother of the child WAS married to .....(name)..... at
the probable time of conception of the child.
OR
The mother of the child WAS NOT married at the probable
time of conception of the child.
OR
I do not know whether or not the mother was married at the
probable time of conception of the child.
5. The mother of this child WAS married to .....(name)..... at
the time of this child’s birth.
OR
The mother of this child WAS NOT married at the time of this
child’s birth.
OR
I do not know whether the mother of this child was married at
the time of this child’s birth.
6. The mother of this child WAS living with/cohabiting with
.....(name)..... at the time of the probable conception of this child.
OR
The mother of this child WAS NOT living with/cohabiting with
any man at the probable time of conception of this child.
OR
I do not know whether the mother of this child was living
with/cohabiting with any man at the probable time of conception of
this child.
7. The mother of this child HAS received payments or
promises of child support with respect to this child or because of
her pregnancy from .....(name)......
OR
The mother of this child HAS NOT received payments or
promises of child support with respect to this child or because of
her pregnancy from anyone.
OR
I do not know whether the mother has received any payments.
8. The mother named .................... as the father on the
child’s birth certificate.
OR
The mother DID NOT name a father on the child’s birth
certificate.
OR
I do not know whether the mother named a father on the
child’s birth certificate.
9. The mother named .................... as the father of this
child in connection with applying for public assistance.
OR
The mother HAS NOT named anyone as the father of this child
in connection with applying for public assistance.
OR
I do not know whether the mother has named anyone as the
father of this child in connection with applying for public assistance
benefits.
10. .....(Name)..... has been named in a paternity case or
acknowledged paternity in a jurisdiction where the mother lived at
the time of or since the conception of this child or where this child
resides or has resided.
OR
No man has been named in a paternity case or acknowledged
paternity of this child in a jurisdiction where the mother lived at the
time of or since the conception of this child or where this child
resides or has resided.
OR
I do not know if any man has been named in a paternity suit
regarding this child.
11. List the name, date of birth, social security number, and
last-known address of any man listed in this sworn statement:
Name: ……….
Date of birth: ……….
Social Security No.: ……….
Last-known address: ………..
12. Do you know any other information about the identity or
location of any man listed in this sworn statement? ..... Yes ..... No.
If so, please give that information:
I UNDERSTAND THAT THIS DOCUMENT WILL BE FILED WITH
THE COURT. UNDER PENALTY OF PERJURY, I DECLARE THAT
I HAVE READ IT AND THAT THE FACTS STATED ARE TRUE.
Date: ..........
Signature
Witnessed by .....(name)....., who is an authorized agent of the
Department of Children and Family Services and who attests that
the person who signed this statement provided proof of identify as
indicated:
..... Driver’s license, number:
………………………………...........…
..... Passport, number and country:
……………………………...........
..... Resident Alien (Green Card), number:
…………………..........…
..... Armed Forces Identification, number:
…………………..........….
..... Other: …………………………………………………….........…
FORM 8.970. ORDER ON JUDICIAL REVIEW
ORDER ON JUDICIAL REVIEW AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(name)....., Child
..... .....(name)....., Attorney for the child
..... .....(name)....., Petitioner
..... .....(name)....., Attorney for the petitioner
..... .....(name)....., Attorney for the department
..... .....(name)....., Department caseworker
..... .....(name)....., Mother
..... .....(name)....., Attorney for mother
..... .....(name)....., Father of .....(child).....
..... .....(name)....., Attorney for father
..... .....(name)....., Guardian ad litem
..... .....(name)....., Attorney for guardian ad litem
..... .....(name)....., Legal custodian
..... .....(name)....., Attorney for legal custodian
..... .....(name)....., 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 considered
..... Judicial Review and Social Study Report filed by the
department
..... Statement/home study filed by the department
..... Report of the guardian ad litem
..... Case plan filed by the department
..... Statement by the Child’s Caretaker
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child
..... Other ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings was/were adjudicated dependent, continue to
be dependent, is/are of an age subject to the jurisdiction of the
court, and is/are resident(s) of the state of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(name)....., Petitioner
..... .....(name)....., Attorney for the petitioner
..... .....(name)....., Attorney for the department
..... .....(name)....., Department caseworker
..... .....(name)....., Mother
..... .....(name)....., Attorney for mother
..... .....(name)....., Father of .....(child).....
..... .....(name)....., Attorney for father
..... .....(name)....., Guardian ad litem
..... .....(name)....., Attorney for guardian ad litem
..... .....(name)....., Legal custodian
..... .....(name)....., Attorney for legal custodian
..... .....(name)....., Attorney for the child
..... .....(name)....., Other ..........
3. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived
..... did not waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent
and
..... was ..... was not appointed an attorney.
4. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived .....
did not waive her right to legal counsel; and
..... was ..... was not determined to qualify as
indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
5. The department filed a judicial review report with the
court on .....(date)...... This judicial review report ..... is ..... is not in
compliance with the statutory requirements.
6. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
7. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
8. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
9. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
10. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
11. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
12. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
13. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
14. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
15. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
16. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
17. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
18. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 19, 20, 21, 22, 23, & 24 if child(ren) is/are not
placed in the home of a parent.
..... 19. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)......
..... 20. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
..... 21. The children ..... are ..... are not separated in their
placements. The following efforts have been made to reunite
separated siblings: ..........
..... It is not in the best interest of each sibling to be reunited in
their placement because: ..........
..... Each sibling has the following frequency, kind and duration of
contacts: ..........
..... 22. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally removed).....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely .....remain .....return home
with services and removal of the child(ren) is necessary to protect
the child(ren).
..... 23. Prevention or reunification services .....were not .....were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
..... 24. The likelihood of the children’s reunification with the
parent or legal custodian within 12 months is ...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
..... 25. The child(ren) can safely ..... remain with ..... be returned
to .....(parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ...........
The safety, well-being, and physical, mental, and emotional health
of the child(ren) are not endangered by allowing the child(ren) to .....
remain ..... return home.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the
custody of .....(name)....., under supervision of the department. The
department shall have placement and care responsibility while the
child(ren) is/are under protective supervision in an out-of-home
placement.
2. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
..... 3. The court finds that it is not likely that the
child(ren) will be reunified with the parent or legal custodian within
12 months after the child was removed from the home. The
department shall file a motion within 10 days of receipt of this
written order to amend the case plan to incorporate concurrent
planning into the case plan.
4. The court inquired of any parents present whether they
have relatives who might be considered for placement of the
children.
5. Other: ...........
6. All prior orders not inconsistent with the present order
shall remain in full force and effect.
7. This court shall retain jurisdiction over this cause to
enter any such further orders as may be deemed necessary for the
best interest and welfare of the minor child(ren).
8. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in .........., Florida on .....(date)..... at
.....(time).....
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.973A. ORDER ON JUDICIAL REVIEW FOR CHILD AGE
16
ORDER ON JUDICIAL REVIEW FOR CHILD
OVER AGE 16 AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department
that includes specific information related to the life skills that the
child has acquired since the child’s 13th birthday or since the date
the child came into foster care, whichever came later;
..... Statement/homestudy filed by the department;
..... Report of the guardian ad litem;
..... A case plan, dated .........., filed by the department;
..... Statement by the child’s caretaker on the progress the child
has made in acquiring independent living skills;
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings was/were adjudicated dependent, continue to
be dependent, is/are of an age subject to the jurisdiction of the
court, and is/are resident(s) of the state of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other: ..........
3. The child has been given the opportunity to address the
court with any information relevant to the child’s best interests.
4. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented by
legal counsel;
..... appeared ..... with ..... without legal counsel and ..... was
..... was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented by
legal counsel;
..... appeared ..... with ..... without legal counsel and ..... was
..... was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive his right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
6. The department filed a judicial review report with the
court on .....(date)...... This judicial review report ..... is ..... is not in
compliance with the statutory requirements.
7. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
8. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
9. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
10. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
11. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
12. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
13. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
14. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
15. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
16. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
17. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
18. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
19. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 20, 21, 22, 23, & 24 if child(ren) is/are not placed
in the home of a parent.
..... 20. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)...... The
department has placement and care responsibility while the
child(ren) is/are under protective supervision in an out-of-home
placement.
..... 21. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
..... 22. The children ..... are ..... are not separated in their
placements. The following efforts have been made to reunite the
siblings: ..........
..... It is not in the siblings’ best interest to be reunited in their
placement because: ..........
..... The separate siblings have the following frequency, kind,
and duration of contacts: ..........
..... 23. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally removed).....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely ..... remain ..... return home
with services and removal of the child(ren) is necessary to protect
the child(ren).
..... 24. Prevention or reunification services ..... were not ..... were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
..... 25. The child(ren) can safely ..... remain with ..... be returned
to .....(parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ........... The safety, well-being, and physical,
mental, and emotional health of the child(ren) are not endangered
by allowing the child(ren) to ..... remain ..... return home.
..... 26. The child’s petition and application for special immigrant
juvenile status or other immigration decision remains pending.
..... 27. The department ….. has ….. has not complied with its
obligation as specified in the written case plan or in the provision of
independent living services as required by Florida Statutes.
..... 28. The child has acquired the following life skills: ..........
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the custody
of .....(name)....., under supervision of the department.
2. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
3. Other: ...........
4. All prior orders not inconsistent with the present order shall
remain in full force and effect.
5. This court shall retain jurisdiction over this cause to enter any
such further orders as may be deemed necessary for the best
interest and welfare of the minor child(ren).
6. This court shall retain jurisdiction until the final decision is
rendered by the federal immigration authorities, or upon the
immigrant child’s 22nd birthday, whichever shall occur first.
7. This court shall retain jurisdiction until the child’s 19th
birthday for the purpose of determining whether appropriate
services to be provided to the young adult before reaching 18 years
of age have been provided to the youth.
8. This court shall retain jurisdiction until the child’s 21st
birthday, or 22nd birthday if the child has a disability, unless the
young adult chooses to leave foster care upon reaching 18 years of
age, or if the young adult does not meet the eligibility requirements
to remain in foster care or chooses to leave care at any time prior to
the 21st birthday, or 22nd birthday if the child has a disability.
9. This matter is scheduled for Judicial Review on .....(date)..... at
.....(time)......
DONE AND ORDERED in .........., Florida, on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to ...........
FORM 8.973B. ORDER ON JUDICIAL REVIEW FOR CHILD AGE
17 OR OLDER
ORDER ON JUDICIAL REVIEW FOR CHILD
OVER AGE 17 AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department;
..... Because the child reached the age of 17 within the past 90
days, written verification that the child:
..... Has been provided with a current Medicaid card
and has been provided all necessary information concerning the
Medicaid program;
..... Has been provided with a certified copy of his or her
birth certificate; and has a valid Florida driver’s license or has been
provided with a Florida identification card;
..... Has a social security card and has been provided
information relating to Social Security Insurance benefits, if the
child is believed to be eligible;
..... Has received a full accounting if there is a Master
Trust for the child and has been informed as to how to access those
funds;
..... Has been provided with information related to the
Road-to-Independence Program, including eligibility requirements,
information on participation, and assistance in gaining admission
to the program; If the child is eligible for the Road-to-Independence
Program, has been informed that he or she may reside with the
licensed foster family or group care provider with whom the child
was residing at the time of attaining his or her 18th birthday or
may reside in another licensed foster home or with a group care
provider arranged by the department;
..... Has an open bank account or the identification
necessary to open a bank account and the information necessary to
acquire essential banking and budgeting skills;
..... Has been provided with information on public
assistance and how to apply;
..... Has been provided a clear understanding of where
he or she will be living on his or her 18th birthday, how living
expenses will be paid, and what educational program the child will
be enrolled in;
..... Has been provided with information as to the child’s
ability to remain in care until he [or she] reaches 21 years of age or
22 years of age if he/she has a disability;
..... Has been provided with a letter stating the dates
that the child is under the jurisdiction of the court;
..... Has been provided with a letter stating that the
child is in compliance with financial aid documentation
requirements;
..... Has been provided his or her educational records;
..... Has been provided his or her entire health and
mental health records;
..... Has been provided with information concerning the
process for accessing his or her case file;
..... Has been provided with a statement encouraging
the child to attend all judicial review hearings occurring after his or
her 17th birthday; and
..... Has been provided with information on how to
obtain a driver license or learner’s driver license.
..... Statement/homestudy filed by the department;
..... Report of the guardian ad litem;
..... A case plan, dated .........., filed by the department;
..... Statement by the child’s caretaker on the progress the child
has made in acquiring independent living skills;
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings was/were adjudicated dependent, continue to
be dependent, is/are of an age subject to the jurisdiction of the
court, and is/are resident(s) of the state of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other: ..........
3. The child has been given the opportunity to address the
court with any information relevant to the child’s best interests.
4. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented by
legal counsel;
..... appeared ..... with ..... without legal counsel and ..... was
..... was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented by legal
counsel;
..... appeared ..... with ..... without legal counsel and ..... was .....
was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive his right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
6. The department filed a judicial review report with the
court on .....(date)...... This judicial review report ..... is ..... is not in
compliance with the statutory requirements.
7. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
8. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
9. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
10. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
11. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
12. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
13. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
14. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
15. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
16. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
17. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
18. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
19. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 20, 21, 22, 23, & 24 if child(ren) is/are not placed
in the home of a parent.
..... 20. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)......
The department has placement and care responsibility while
the child(ren) is/are under protective supervision in an out-of-
home placement.
..... 21. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family
like and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
..... 22. The children ..... are ..... are not separated in their
placements. The following efforts have been made to reunite
the siblings: ..........
..... It is not in the siblings’ best interest to be reunited in their
placement because: ..........
..... The separate siblings have the following frequency, kind, and
duration of contacts: ..........
..... 23. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally
removed)..... would be contrary to the best interest and welfare of
the minor child(ren). The child(ren) cannot safely ..... remain .....
return home with services and removal of the child(ren) is necessary
to protect the child(ren).
..... 24. Prevention or reunification services ..... were not ..... were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
..... 25. The child(ren) can safely ..... remain with ..... be returned
to .....(parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ........... The safety, well-being, and physical,
mental, and emotional health of the child(ren) are not endangered
by allowing the child(ren) to ..... remain ..... return home.
..... 26. The child’s petition and application for special immigrant
juvenile status or other immigration decision remains pending.
..... 27. The department ….. has ….. has not complied with its
obligation as specified in the written case plan or in the provision of
independent living services as required by Florida Statutes.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the
custody of .....(name)....., under supervision of the department.
2. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
3. Other: ...........
4. All prior orders not inconsistent with the present order
shall remain in full force and effect.
5. This court shall retain jurisdiction over this cause to
enter any such further orders as may be deemed necessary for the
best interest and welfare of the minor child(ren).
6. This court shall retain jurisdiction until the final decision
is rendered by the federal immigration authorities, or upon the
immigrant child’s 22nd birthday, whichever shall occur first.
7. This court shall retain jurisdiction until the child’s 19th
birthday for the purpose of determining whether appropriate
services to be provided to the young adult before reaching 18 years
of age have been provided to the youth.
8. This court shall retain jurisdiction until the child’s 21st
birthday, or 22nd birthday if the child has a disability, unless the
young adult chooses to leave foster care upon reaching 18 years of
age, or if the young adult does not meet the eligibility requirements
to remain in foster care or chooses to leave care at any time prior to
the 21st birthday, or 22nd birthday if the child has a disability.
9. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in .........., Florida, on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to ...........
FORM 8.973C. ORDER ON JUDICIAL REVIEW
ORDER ON LAST JUDICIAL REVIEW BEFORE CHILD REACHES
AGE 18 AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department;
..... Statement/homestudy filed by the department;
..... Report of the guardian ad litem;
..... A case plan, dated .........., filed by the department that
includes information related to independent living services that
have been provided since the child’s 13th birthday or since the date
the child came into foster care, whichever came later;
..... Statement by the child’s caretaker on the progress the child
has made in acquiring independent living skills;
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child;
..... A copy of the child’s transition plan;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who …..is/are….. the subject
matter of these proceedings …..was/were….. adjudicated
dependent, continue to be dependent, is/are of an age subject to
the jurisdiction of the court, and …..is/are.....resident(s) of the state
of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other: ..........
3. The child has been given the opportunity to address the
court with any information relevant to the child’s best interests.
4. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented by legal
counsel;
..... appeared ..... with ..... without legal counsel and ..... was .....
was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented by legal
counsel;
..... appeared ..... with ..... without legal counsel and ..... was .....
was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive his right to legal counsel; and
.... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
6. The department filed a judicial review report with the
court on .....(date)...... The judicial review report ..... is ..... is not in
compliance with the statutory requirements.
7. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
8. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
9. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
10. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
11. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
12. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
13. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
14. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
15. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
16. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
17. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
18. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
19. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 20, 21, 22, 23, & 24 if child(ren) is/are not placed
in the home of a parent.
20. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)...... The
department has placement and care responsibility while the
child(ren) is/are under protective supervision in an out-of-home
placement.
21. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)'s best interests and special needs.
..... 22. The children ..... are ..... are not separated in
their placements. The following efforts have been made to reunite
separated siblings: ..........
..... It is not in the best interest of each sibling to be reunited in
their placement because: ..........
..... Each sibling has the following frequency, kind, and duration of
contacts: ..........
23. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally removed).....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely ..... remain ..... return home
with services and removal of the child(ren) is necessary to protect
the child(ren).
24. Prevention or reunification services ..... were not ..... were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
25. The child(ren) can safely ..... remain with ..... be returned to
..... (parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ........... The safety, well-being, and physical,
mental, and emotional health of the child(ren) are not endangered
by allowing the child(ren) to ..... remain ..... return home.
26. The child’s petition and application for special immigrant
juvenile status or other immigration decision remains pending.
27. The department ..... has ..... has not complied with its
obligation as specified in the written case plan or in the provision of
independent living services as required by Florida Statutes.
..... 28. The child does plan on remaining in foster care.
a. the child will meet the requirements by ..........
b. the supervised living arrangement will be ..........
c. the child has been informed of
..... (1) the right to continued support and
services;
..... (2) the right to request termination of this
court’s jurisdiction and to be discharged from
foster care;
..... (3) the opportunity to reenter foster care
pursuant to Florida law; and
..... (4) the requirement to furnish
documentation of participation in a program
required for eligibility to remain in extended
foster care.
..... 29. The child does not plan on remaining in foster care.
The child has been informed of:
..... a. services of benefits for which the child may be
eligible based upon the child’s placement and length of time spent
in licensed foster care;
..... b. services or benefits that may be lost through a
termination of the court’s jurisdiction; and
..... c. other federal, state, local, or community-based
services or supports available to the child.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the
custody of .....(name)....., under supervision of the department.
2. The judicial review report filed by the department is: .....
not accepted and a continuance was requested ..... accepted by the
court.
3. The child’s transition plan is: ..... not approved and a
continuance was requested ..... approved by the court.
4. Other: ..........
5. All prior orders not inconsistent with the present order
shall remain in full force and effect.
6. This court shall retain jurisdiction over this cause to
enter any such further orders as may be deemed necessary for the
best interest and welfare of the minor child(ren).
7. This court shall retain jurisdiction until the final decision
is rendered by the federal immigration authorities, or upon the
immigrant child’s 22nd birthday, whichever shall first occur.
8. This court shall retain jurisdiction until the child’s 19th
birthday for the purpose of determining whether appropriate
services that were required to be provided to the young adult before
reaching 18 years of age have been provided to the youth.
9. This court shall retain jurisdiction until the child’s 21st
birthday, or 22nd birthday if the child has a disability, unless the
young adult chooses to leave foster care upon reaching 18 years of
age, or if the young adult does not meet the eligibility requirements
to remain in foster care or chooses to leave care at any time prior to
the 21st birthday, or the 22nd birthday if the young adult has a
disability.
10. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in .........., Florida, on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the above-
styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to: ..........
FORM 8.973D. ORDER ON JUDICIAL REVIEW FOR YOUNG
ADULTS IN EXTENDED FOSTER CARE
ORDER ON JUDICIAL REVIEW FOR YOUNG ADULTS IN
EXTENDED FOSTER CARE AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Young Adult
..... .....(Name)....., Attorney for the Young Adult
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for the guardian ad litem
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department;
..... Case Plan filed by the department;
..... Report of the guardian ad litem;
..... A copy of the young adult’s transition plan;
..... A copy of the voluntary placement agreement;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. The young adult ….. is ….. is not making progress in
meeting the case plan goals, as follows: ..........
2. The department ..... has or ..... has not made reasonable
efforts to finalize the permanency plan currently in effect.
3. The case plan and/or the young adult’s transition plan
shall be amended as follows: ..........
4. The Department and all services providers .....have …..
have not provided the appropriate services listed in the case plan.
….. The Department must take the following action to ensure the
young adult receives identified services that have not been provided:
..........
…… 5. The young adult ..... is ..... is not separated from siblings
in out-of-home care. The following efforts have been made to reunite
separated siblings: .....................................................
........................................................................................................
...................................................
........................................................................................................
...................................................
..... It is not in the best interest of each sibling to be reunited in
their placement because:
........................................................................................................
........................................................................................................
........................................................................................................
..... Each sibling has the following frequency, kind and duration of
contacts:
........................................................................................................
........................................................................................................
........................................................................................................
…… 6. The young adult has signed a voluntary placement
agreement for the sole purpose of ending the current removal
episode.
….. 7. Jurisdiction in this case should be terminated based on
the following facts:
..... a. The young adult has requested termination of
jurisdiction; or
..... b. The young adult has been informed by the
department of his or her right to attend this hearing and has
provided written consent to waive this right, and
..... c. The young adult has been informed of the potential
negative effects of early termination of care, the option to reenter
care before reaching 21 years of age, or 22 years of age if the young
adult has a disability, the procedure for and the limitations on
reentering care, and the availability of alternative services, and has
signed a document attesting that he or she has been so informed
and understands these provisions; or
..... d. The young adult has voluntarily left the program,
has not signed the document indicated above, and is unwilling to
participate in any further court proceeding; or
..... e. The young adult has been involuntarily discharged
from the program by written notification dated .........., and the
young adult has not appealed the discharge decision.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
2. All prior orders not inconsistent with the present order
shall remain in full force and effect.
3. The young adult is placed in the following supervised
living environment: .......... under the protective supervision of the
department. The department shall have placement and care
responsibility while the young adult is under protective supervision
in the supervised living environment. The court has determined that
it is in the best interest of the young adult to remain in out-of-home
care.
..... 4. The court ends the current removal episode. The
young adult executed a voluntary placement agreement on
.....(date)..... giving the department placement and care
responsibility and beginning a new removal episode.
..... 5. This court shall retain jurisdiction until the young
adult’s 19th birthday for the purpose of determining whether
appropriate services that were required to be provided to the young
adult before reaching 18 years of age have been provided to the
youth. or
..... 6. This court shall retain jurisdiction until the young
adult’s 21st birthday, or 22 years of age if the young adult has a
disability, unless the young adult chooses to leave foster care upon
reaching 18 years of age, or if the young adult does not meet the
eligibility requirements to remain in foster care or chooses to leave
care at any time prior to the 21st birthday. or
..... 7. Jurisdiction over this cause is hereby terminated.
..... 8. Other:…………………..
..... 9. This matter is scheduled for Judicial Review on
…..(date)….. at ……(time)…….
DONE AND ORDERED in …………………, Florida, on ……(date)…….
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at ..... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to: ……….
FORM 8.975. DEPENDENCY ORDER WITHHOLDING
ADJUDICATION
ORDER OF ADJUDICATION
THIS CAUSE came before this court on .....(date)....., under
chapter 39, Florida Statutes, for adjudication of the Petition for
Dependency filed by .....(petitioner’s name)...... Present before the
court were
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
The court having heard testimony and argument and being
otherwise fully advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings, is/are dependent within the meaning and
intent of chapter 39, Florida Statutes, and is/are (a) resident(s) of
the State of Florida.
2. The mother, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of her right to legal
counsel,
..... knowingly, intelligently, and voluntarily waived .....
did not waive her right to legal counsel and
..... was ..... was not determined to qualify as indigent
and
..... was ..... was not appointed an attorney.
3. The father, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of his right to legal
counsel,
..... knowingly, intelligently, and voluntarily waived
..... did not waive his right to legal counsel
and
..... was ..... was not determined to qualify as
indigent and
..... was ..... was not appointed an attorney.
..... 4. That the child(ren) is/are dependent within the meaning
and intent of chapter 39, Florida Statutes, in that the mother,
....(name)....., abused, neglected or abandoned the minor child(ren)
by .................... These facts were proven by ..... preponderance of
the evidence ...... clear and convincing evidence.
..... 5. That the child(ren) is/are dependent within the meaning
and intent of chapter 39, Florida Statutes, in that the father,
.....(name)....., abused, neglected or abandoned the minor child(ren)
by ..................... These facts were proven by ..... preponderance of
the evidence ...... clear and convincing evidence.
..... 6. That the parties have filed a mediation agreement in
which the parent(s) consent(s) to the adjudication of dependency of
the child(ren) in conjunction with a withhold of adjudication, which
the court accepts.
7. Under section 39.507(5), Florida Statutes, the Court
finds that the child(ren) named in the petition are dependent, but
finds that no action other than supervision in the child(ren)’s home
is required.
THEREFORE, based upon the foregoing findings, it is
ORDERED AND ADJUDGED that:
1. Under section 39.507(5), Florida Statutes, the Court
hereby withholds adjudication of dependency of the minor
child(ren). The child(ren) shall be .....returned/continued..... in
(child(ren)’s home) under the supervision of the department. If this
court later finds that the parents have not complied with the
conditions of supervision imposed, the court may, after a hearing to
establish the noncompliance, but without further evidence of the
state of dependency, enter an order of adjudication.
2. This court shall retain jurisdiction over this cause to
enter any such further orders that may be deemed necessary for the
best interest and welfare of the minor child(ren).
3. All prior orders not inconsistent with the present order
shall remain in full force and effect.
4. Disposition is scheduled for .....(date)....., at ......
a.m./p.m.
DONE AND ORDERED on .....date......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.976. PROPOSED RELATIVE PLACEMENT
PROPOSED RELATIVES FOR PLACEMENT
Pursuant to Chapter 39, Florida Statutes, the
.....mother/father..... hereby provides the court and the parties with
the names and location of relatives who might be considered for
placement of the child(ren). The .....mother/father..... will continue
to inform the court and the parties of any relative who should be
considered for placement of the child(ren) with the filing of
subsequent forms.
MATERNAL
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
PATERNAL
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
The above information is true and correct to the best of my
knowledge.
Dated ....................
(Mother’s Signature)
Printed name
……………….................
(Father’s Signature)
Printed name
……………….................
FORM 8.977. ORDER AUTHORIZING CHILD TO ENTER INTO
RESIDENTIAL LEASEHOLD AND SECURE
UTILITY SERVICES BEFORE THE CHILD’S 18TH
BIRTHDAY
ORDER AUTHORIZING CHILD TO ENTER INTO RESIDENTIAL
LEASEHOLD
AND TO SECURE RESIDENTIAL UTILITY SERVICES BEFORE THE
CHILD’S 18TH BIRTHDAY
THIS CAUSE came before the court to remove the disabilities
of nonage of .....(name)....., for the purpose of entering into a
residential leasehold and to secure residential utility services. The
court being fully advised in the premises FINDS as follows:
.....(Name)..... is 17 years of age, meets the requirements of
sections 743.045 and 743.046, Florida Statutes, and is entitled to
the benefits of those statutes.
THEREFORE, based on these findings of fact, it is ORDERED
AND ADJUDGED that the disabilities of nonage of .....(name)..... are
hereby removed for the purpose of entering a residential leasehold
and securing residential utility services. .....(Name)..... is hereby
authorized to make and execute contracts, releases, and all other
instruments necessary for the purpose of entering into a residential
leasehold and securing residential utility services. The contracts or
other instruments made by .....(name)..... for the purposes of
entering into a residential leasehold and securing residential utility
services shall have the same effect as though they were the
obligations of a person who is not a minor.
ORDERED at ..................................., Florida, on .....(date)......
Circuit Judge
Copies to:
FORM 8.978. ORDER AUTHORIZING CHILD TO SECURE
DEPOSITORY FINANCIAL SERVICES BEFORE
THE CHILD’S 18TH BIRTHDAY
ORDER AUTHORIZING CHILD TO SECURE
DEPOSITORY FINANCIAL SERVICES
BEFORE THE CHILD’S 18TH BIRTHDAY
THIS CAUSE came before the court to remove the disabilities
of nonage of .....(name)....., for the purpose of securing depository
financial services, and the court being fully advised in the premises
FINDS as follows:
.....(Name)..... is at least 16 years of age, meets the
requirements of section 743.044, Florida Statutes, and is entitled to
the benefits of that statute.
THEREFORE, based on these findings of fact, it is ORDERED
AND ADJUDGED that the disabilities of nonage of .....(name)..... are
hereby removed for the purpose of securing depository financial
services. .....(Name)..... is hereby authorized to make and execute
contracts, releases, and all other instruments necessary for the
purpose of securing depository financial services. The contracts or
other instruments made by .....(name)..... for the purpose of
securing depository financial services have the same effect as
though they were the obligations of a person who is not a minor.
ORDERED at ……….., Florida, on .....(date)......
Circuit Judge
Copies to:
FORM 8.978(a). ORDER CONCERNING YOUTH’S
ELIGIBILITY FOR FLORIDA’S TUITION AND FEE
EXEMPTION.
ORDER CONCERNING ELIGIBILITY FOR FLORIDA’S TUITION
AND FEE EXEMPTION
THIS CAUSE comes before the court to determine
.....(name).....’s eligibilty for the tuition and fee exemption under
Chapter 1009, Florida Statutes, and the court being fully advised in
the premises, it is
ORDERED AND ADJUDGED that .....(name)..... is eligible,
under Chapter 1009, Florida Statutes, and therefore exempt from
the payment of tuition and fees, including lab fees, at a school
district that provides postsecondary career programs, community
college, or state university.
ORDERED at………., Florida, on .....(date).....
Circuit Judge
Copies to:
D. TERMINATION OF PARENTAL RIGHTS FORMS
FORM 8.979. SUMMONS FOR ADVISORY HEARING
SUMMONS AND NOTICE OF ADVISORY
HEARING FOR TERMINATION OF
PARENTAL RIGHTS AND GUARDIANSHIP
STATE OF FLORIDA
TO: .....(name and address of person being summoned).....
A Petition for Termination of Parental Rights under oath has been
filed in this court regarding the above-referenced child(ren), a copy
of which is attached. You are to appear before .....(judge)....., at
.....(time and location of hearing)....., for a TERMINATION OF
PARENTAL RIGHTS ADVISORY HEARING. You must appear on the
date and at the time specified.
FAILURE TO APPEAR AT THIS ADVISORY HEARING
CONSTITUTES CONSENT TO THE TERMINATION OF PARENTAL
RIGHTS TO THIS CHILD (THESE CHILDREN). IF YOU FAIL TO
APPEAR ON THE DATE AND TIME SPECIFIED YOU MAY LOSE
ALL LEGAL RIGHTS TO THE CHILD (OR CHILDREN) NAMED IN
THE PETITION ATTACHED TO THIS NOTICE.
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 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.
Witness my hand and seal of this court at .....(city, county,
state)..... on .....(date)......
CLERK OF COURT
BY:
DEPUTY CLERK
CITATORIO Y AVISO DE
AUDIENCIA PARA LA TERMINACIÓN DE
PATRIA POTESTAD Y TUTELA
ESTADO DE FLORIDA
PARA: ..... (nombre y dirección de la persona citada).....
Se ha presentado una Petición de Terminación de la Patria Potestad
bajo juramento en este tribunal con respecto a los niños
mencionados anteriormente, cuya copia se adjunta. Usted debe
comparecer ante ..... (juez)....., en ..... (hora y lugar de la
audiencia)....., para una AUDIENCIA CONSULTIVA DE
TERMINACIÓN DE LA PATRIA POTESTAD. Deberá presentarse en
la fecha y hora que se especifiquen.
LA FALTA DE COMPARECENCIA EN ESTA AUDIENCIA
CONSULTIVA CONSTITUYE SU CONSENTIMIENTO PARA LA
TERMINACIÓN DE LA PATRIA POTESTAD DE ESTE NIÑO
(ESTOS NIÑOS). SI NO SE PRESENTA EN LA FECHA Y HORA
ESPECIFICADAS, PUEDE PERDER TODOS LOS DERECHOS
LEGALES SOBRE EL NIÑO (O NIÑOS) NOMBRADOS EN LA
PETICIÓN ADJUNTA A ESTE CITATORIO.
COMENTARIO: El siguiente párrafo debe estar en negrita, 14 pt.
fuente Times New Roman o Courier.
Si usted es una persona con una discapacidad que necesita
alguna adaptación para participar en este procedimiento, tiene
derecho, sin costo alguno para usted, a que se le provea de
cierta asistencia. Póngase en contacto con ..... (nombre,
dirección, número de teléfono)..... al menos 7 días antes de su
comparecencia programada ante el tribunal, o inmediatamente
después de recibir esta notificación si el tiempo antes de la
comparecencia programada es inferior a 7 días. Si tiene
problemas de audición o de voz, llame al 711.
Doy fe con mi firma y sello de este tribunal en ..... (ciudad,
condado, estado)..... en..... (fecha)......
SECRETARIO DEL TRIBUNAL
POR:
SECRETARIO ADJUNTO
MANDA AK AVÈTISMAN POU ENFOME-W
SOU YON CHITA TANDE, POU YO ANILE DWA-W
KÒM PARAN AK KÒM GADYEN
Leta Florid
POU: .....(non ak adrès moun yo voye manda-a).......
KÒM, tandiske, gen yon demann sèmante pou anile dwa paran-yo,
ki prezante devan tribinal-la, konsènan timoun ki nonmen nan lèt
sa-a, piwo-a, yon kopi dokiman-an kwoke nan dosye-a., yo bay lòd
pou prezante devan ..... (Jij-la) ...., a..... (nan.lè ak adrès chita
tande-a)......, NAN YON CHITA TANDE POU YO ENFÒME-W, YO
GEN LENTANSYON POU ANILE DWA-OU KÒM PARAN. Ou fèt pou
prezante nan dat ak lè ki endike-a.
SI OU PA PREZANTE NAN CHITA TANDE-A, POU YO ENFÒME-W,
YO GEN LENTANSYON POU ANILE DWA-OU KÒM PARAN, SA KA
LAKÒZ YO DESIDE OU KONSANTI TIMOUN SA-A (YO), BEZWEN
PWOTEKSYON LETA EPI SA KA LAKÒZ OU PÈDI DWA-OU KÒM
PARAN TIMOUN SA-A(YO), KI GEN NON YO MAKE NAN KOPI
DEMANN-NAN, KI KWOKE NAN AVÈTISMAN-AN
Si ou se yon moun infirm, ki beswen `ed ou ki bewsen ke o
akomode w pou ou patispe nan pwosedi sa yo, ou genyen dwa,
san ke ou pa peye, a setin `ed. Silvouple kontake …..(non,
address, telephone)….. o moin 7 jou avan dat ou genyen
rendevou pou ale nan tribunal, ou si le ou resevwa avi a, genyen
mouins ke 7 jou avan date endevou tribunal la. Ou si ou pa
tande pale, rele nan nimerro sa 711.
Mwen siyen non mwen e mete so mwen nan dokiman tribinal-
la kòm temwen nan (vil, distrik, eta) ....., nan ... (dat).......
GREFYE TRIBINAL-LA
PA:
ASISTAN GREFYE TRIBINAL-LA
FORM 8.980. PETITION FOR TERMINATION OF PARENTAL
RIGHTS BASED ON VOLUNTARY
RELINQUISHMENT
PETITION FOR TERMINATION OF
PARENTAL RIGHTS
Petitioner, .....(name)....., respectfully petitions this Court for
termination of parental rights and permanent commitment of the
minor child(ren), .....(name(s))....., to .....(agency name)..... for the
purpose of subsequent adoption, and as grounds states the
following:
A. PARTIES
1. The child, .....(name)....., is a male/female child born on
.....(date)....., at .....(city, county, state)...... At the time of the filing of
this petition, the child is .....(age)...... A copy of the child’s birth
certificate is attached to this Petition and incorporated as
Petitioner’s Exhibit ......
COMMENT: Repeat above for each child on petition.
2. The child(ren) is/are presently in the care and custody of
.....(name)....., and is/are residing in .................... County, Florida.
3. An affidavit under the Uniform Child Custody
Jurisdiction and Enforcement Act is attached to this as Petitioner’s
Exhibit .......
4. The natural mother of the child(ren) is .....(name)....., who
resides at ....................
5. The natural/alleged/putative father of the child(ren)
.....(name(s))..... is .....(name)....., who resides at ....................
COMMENT: Repeat #5 as necessary.
6. A guardian ad litem ..... has ..... has not been appointed
to represent the interests of the child(ren) in this cause.
B. GROUNDS FOR TERMINATION
1. The parent(s) have been advised of their right to legal
counsel at all hearings that they attended.
2. The parents will be informed of the availability of private
placement of the child with an adoption entity as defined in chapter
63, Florida Statutes.
3. The mother, .....(name)....., freely, knowingly, voluntarily,
and ..... with ..... without advice of legal counsel executed an
Affidavit and Acknowledgment of Surrender, Consent, and Waiver of
Notice on .....(date)....., for termination of her parental rights to the
minor child, .....(name)....., under section 39.806(1)(a), Florida
Statutes.
COMMENT: Repeat above as necessary.
4. The father, .....(name)....., freely, knowingly, and
voluntarily, and ..... with ..... without advice of legal counsel
executed an Affidavit and Acknowledgment of Surrender, Consent,
and Waiver of Notice on .....(date)....., for termination of his parental
rights to the minor child, .....(name)....., under section 39.806(1)(a),
Florida Statutes.
COMMENT: Repeat above as necessary.
5. Under the provisions of chapter 39, Florida Statutes, it is
in the manifest best interest of the child(ren) for parental rights to
be terminated for the following reasons:
..... allegations which correspond to sections 39.810(1)–
(11), Florida Statutes.
6. A copy of this petition shall be served on the natural
mother, .....(name).....; the father(s), .....(name(s)).....; the custodian,
.....(name).....; and the guardian ad litem, .....(name)......
7. This petition is filed in good faith and under oath.
WHEREFORE, the petitioner respectfully requests that this
court grant this petition; find that the parents have voluntarily
surrendered their parental rights to the minor child(ren); find that
termination of parental rights is in the manifest best interests of
this/these child(ren); and that this court enter an order
permanently committing this/these child(ren) to the .....(name).....
for subsequent adoption.
.....(petitioner’s name and
identifying information).....
Verification
.....(attorney’s name).....
.....(address and telephone
number).....
.....(email address(es).....
.....(Florida Bar number).....
Certificate of Service
FORM 8.981. PETITION FOR INVOLUNTARY TERMINATION OF
PARENTAL RIGHTS
PETITION FOR TERMINATION
OF PARENTAL RIGHTS
Petitioner, .....(petitioner’s name)....., respectfully petitions this
court for termination of parental rights and permanent commitment
of the minor child(ren), .....(name(s))....., to .....(agency name)..... for
the purpose of subsequent adoption, and as grounds states the
following:
A. PARTIES
1. The child, .....(name)....., is a male/female child born on
.....(date)....., at .....(city, county, state)...... At the time of the filing of
this petition, the child is .....(age)...... A copy of the child’s birth
certificate is attached to this Petition and incorporated as
Petitioner’s Exhibit ......
COMMENT: Repeat above for each child on petition.
2. The child(ren) is/are presently in the care and custody of
.....(name)....., and is/are residing in ………. County, Florida.
3. An affidavit under the Uniform Child Custody
Jurisdiction and Enforcement Act is attached to this as Petitioner’s
Exhibit ......
4. The natural mother of the child(ren) is .....(name)....., who
resides at …………
5. The natural/alleged/putative father of the child(ren)
.....(name(s))..... is .....(name)....., who resides at
……………………………………….
COMMENT: Repeat #5 as necessary.
6. A guardian ad litem ..... has ..... has not been appointed
to represent the interests of the child(ren) in this cause.
B. GROUNDS FOR TERMINATION
1. The parents have been advised of their right to legal
counsel at all hearings that they attended.
2. On or about .....(date(s))....., the following occurred:
.....(acts which were basis for dependency or TPR, if filed
directly)......
3. The mother has .....(grounds for TPR)..... the minor
child(ren) within the meaning and intent of section 39.806, Florida
Statutes, in that: .....(allegations which form the statutory basis for
grounds)......
4. The father has .....(grounds for TPR)..... the minor
child(ren) within the meaning and intent of section 39.806, Florida
Statutes, in that: .....(allegations which form the statutory basis for
grounds)......
5. Under the provisions of sections 39.810(1)–(11), Florida
Statutes, it is in the manifest best interests of the child(ren) for
parental rights of .....(name(s))..... to be terminated for the following
reasons: .....(allegations for each statutory factor in the manifest
best interest test)......
6. A copy of this petition shall be served on the natural
mother, .....(name)....., father(s), .....(name(s))....., the custodian,
.....(name).....; and the guardian ad litem, .....(name)......
7. This petition is filed by the petitioner in good faith and
under oath.
WHEREFORE, the petitioner respectfully requests that this
court grant this petition; find that the parents have abused,
neglected, or abandoned the minor child(ren); find that termination
of parental rights is in the manifest best interests of this/these
child(ren); and that this court enter an order permanently
committing this/these child(ren) to .....(agency)..... for subsequent
adoption.
.....(petitioner’s name and
identifying information).....
Verification
.....(attorney’s name).....
.....(address and telephone
number).....
.....(Florida Bar number).....
Certificate of Service
FORM 8.982 NOTICE OF ACTION FOR ADVISORY HEARING
.....(Child(ren)’s initials and date(s) of birth).....
NOTICE OF ACTION AND OF ADVISORY HEARING FOR
TERMINATION OF PARENTAL RIGHTS AND
GUARDIANSHIP
STATE OF FLORIDA
TO: .....(name and address of person being summoned)....
A Petition for Termination of Parental Rights under oath has
been filed in this court regarding the above-referenced child(ren).
You are to appear before .....(judge)....., at .....(time and address of
hearing)....., for a TERMINATION OF PARENTAL RIGHTS ADVISORY
HEARING. You must appear on the date and at the time specified.
FAILURE TO APPEAR AT THIS ADVISORY HEARING
CONSTITUTES CONSENT TO THE TERMINATION OF PARENTAL
RIGHTS TO THIS CHILD (THESE CHILDREN). IF YOU FAIL TO
APPEAR ON THE DATE AND TIME SPECIFIED YOU MAY LOSE
ALL LEGAL RIGHTS TO THE CHILD (OR CHILDREN) WHOSE
INITIALS APPEAR ABOVE.
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 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.
Witness my hand and seal of this court at .....(city, county,
state)..... on .....(date)......
CLERK OF COURT
BY:
DEPUTY CLERK
..... (Iniciales del niño (s) y fecha (s) de nacimiento).....
NOTIFICACIÓN DE AUDIENCIA CONSULTIVA PARA LA
TERMINACIÓN DE LA PATRIA POTESTAD Y
TUTELA
ESTADO DE FLORIDA
PARA: ..... (nombre y dirección de la persona citada)....
Se ha presentado una Petición de Terminación de la Patria
Potestad bajo juramento en este tribunal con respecto a los niños
mencionados anteriormente. Usted debe comparecer ante .....
(juez)....., en ..... (hora y dirección de la audiencia)....., para una
AUDIENCIA CONSULTIVA DE TERMINACIÓN DE LA PATRIA
POTESTAD. Deberá presentarse en la fecha y hora que se
especifiquen.
LA FALTA DE COMPARECENCIA EN ESTA AUDIENCIA
CONSULTIVA CONSTITUYE SU CONSENTIMIENTO PARA LA
TERMINACIÓN DE LA PATRIA POTESTAD DE ESTE NIÑO
(ESTOS NIÑOS). SI NO SE PRESENTA EN LA FECHA Y HORA
ESPECIFICADAS, PUEDE PERDER TODOS LOS DERECHOS
LEGALES SOBRE EL NIÑO (O NIÑOS) CUYAS INICIALES
APARECEN ARRIBA.
COMENTARIO: El siguiente párrafo debe estar en negrita, 14 pt.
fuente Times New Roman o Courier.
Si usted es una persona con una discapacidad que necesita
alguna adaptación para participar en este procedimiento, tiene
derecho, sin costo alguno para usted, a que se le provea de
cierta asistencia. Póngase en contacto con ...... (nombre,
dirección, número de teléfono)..... al menos 7 días antes de su
comparecencia programada ante el tribunal, o inmediatamente
después de recibir esta notificación si el tiempo antes de la
comparecencia programada es inferior a 7 días. Si tiene
problemas de audición o de voz, llame al 711.
Doy fe con mi firma y sello de este tribunal en ..... (ciudad,
condado, estado)..... en..... (fecha)......
SECRETARIO DEL TRIBUNAL
POR: ________________________
SECRETARIO ADJUNTO
MANDA AK AVÈTISMAN POU ENFOME-W
SOU YON CHITA TANDE, POU YO ANILE
DWA-W KÒM PARAN AK KÒM GADYEN.
LETA FLORID
POU: .....(non ak adrs moun yo voye manda-a).....
KÒM, tandiske, gen yon demann smante pou anile dwa paran-
yo, ki prezante devan tribinal-la, konsnan timoun ki nonmen nan lt
sa-a, piwo-a, yon kopi dokiman-an kwoke nan dosye-a., yo bay ld
pou prezante devan .....(Jij-la)....., a..... (nan.l ak adrs chita tande-
a)....., NAN YON CHITA TANDE POU YO ENOFME-W, YO GEN
LENTANSYON POU ANILE DWA-OU KÒM PARAN. Ou ft pou
prezante nan dat ak l ki endike-a.
SI OU PA PREZANTE NAN CHITA TANDE-A, POU YO
ENFOME-W, YO GEN LENTANSYON POU ANILE DWA-OU KÒM
PARAN, SA KA LAKÒZ YO DESIDE OU KONSANTI TIMOUN SA-A
(YO), BEZWEN PWOTEKSYON LETA EPI SA KA LAKÒZ OU PEDI
DWA-OU KÒM PARAN TIMOUN SA-A(YO), KI GEN NON YO MAKE
NAN KOPI DEMANN-NAN, KI KWOKE NAN AVÈTISMAN -AN
Si ou se yon moun infirm, ki beswen `ed ou ki bewsen ke o
akomode w pou ou patispe nan pwosedi sa yo, ou genyen dwa,
san ke ou pa peye, a setin `ed. Silvouple kontake …..(non,
address, telephone)….. o moin 7 jou avan dat ou genyen
rendevou pou ale nan tribunal, ou si le ou resevwa avi a, genyen
mouins ke 7 jou avan date endevou tribunal la. Ou si ou pa
tande pale, rele nan nimerro sa 711.
Mwen siyen non mwen e mete so mwen nan dokiman tribinal-
la km temwen nan .....(vil, distrik, eta)....., nan .....(dat)......
GREFYE TRIBINAL-LA
PA:
ASISTAN GREFYE TRIBINAL-LA
FORM 8.983. ORDER INVOLUNTARILY TERMINATING
PARENTAL RIGHTS
ORDER INVOLUNTARILY TERMINATING PARENTAL RIGHTS
THIS CAUSE came before this court on .....(all dates of the adjudicatory
hearing)..... for an adjudicatory hearing on the Petition for Termination of
Parental Rights filed by .....(name) ...... Present before the court were:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Child
..... .....(Name)....., Attorney for Child
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
The court has carefully considered and weighed the testimony of all
witnesses. The court has received and reviewed all exhibits.
COMMENT: Add the following only if necessary.
The petitioner has sought termination of the parental rights of .....(parent(s)) who is/are
subject of petition)......
The court finds that the parent(s), .....(name(s))....., has/have .....(list
grounds proved)....., under chapter 39, Florida Statutes. The grounds were
proved by clear and convincing evidence. Further, the court finds that
termination of parental rights of the parent(s), .....(name(s))....., is clearly in the
manifest best interests of the child(ren). The findings of fact and conclusions of
law supporting this decision are as follows:
1. At all stages of these proceedings the parent(s) was/were advised of
his/her/their right to legal counsel, or was/were in fact represented by
counsel.
2. On or about .....(date(s))....., the following occurred: .....(acts which
were basis for dependency or TPR, if filed directly)......
3. The mother has .....(grounds for TPR)..... the minor child(ren)
within the meaning and intent of section 39.806, Florida Statutes, in that:
.....(findings that form the statutory basis for grounds)......
4. The father has .....(grounds for TPR)..... the minor child(ren) within
the meaning and intent of section 39.806, Florida Statutes, in that:
.....(findings that form the statutory basis for grounds)......
5. The minor child(ren) to whom .....(parent’s(s’) name(s))..... parental
rights are being terminated are at substantial risk of significant harm.
Termination of parental rights is the least restrictive means to protect the
child(ren) from harm.
6. Under the provisions of sections 39.810(1)–(11), Florida Statutes, it
is in the manifest best interests of the child(ren) for parental rights of
.....(name(s))..... to be terminated for the reasons below. The court has
considered all relevant factors and finds as follows:
(a) Regarding any suitable permanent custody arrangement
with a relative of the child(ren), the court finds ...........
(b) Regarding the ability and disposition of the parent or parents
to provide the child(ren) with food, clothing, medical care, or other remedial
care recognized and permitted under state law instead of medical care, and
other material needs of the child(ren), the court finds ...........
(c) Regarding the capacity of the parent or parents to care for
the child(ren) to the extent that the child(ren)’s safety, well-being, and
physical, mental, and emotional health will not be endangered upon the
child(ren)’s return home, the court finds ...........
(d) Regarding the present mental and physical health needs of
the child(ren) and such future needs of the child(ren) to the extent that such
future needs can be ascertained based on the present condition of the
child(ren), the court finds ...........
(e) Regarding the love, affection, and other emotional ties
existing between the child(ren) and the child(ren)’s parent or parents,
siblings, and other relatives, and the degree of harm to the child(ren) that
would arise from the termination of parental rights and duties, the court finds
...........
(f) Regarding the likelihood of an older child remaining in long-
term foster care upon termination of parental rights, due to emotional or
behavioral problems or any special needs of the child(ren), the court finds
...........
(g) Regarding the child(ren)’s ability to form a significant
relationship with a parental substitute and the likelihood that the child(ren)
will enter into a more stable and permanent family relationship as a result of
permanent termination of parental rights and duties, the court finds ...........
(h) Regarding the length of time that the child(ren) has lived in
a stable, satisfactory environment and the desirability of maintaining
continuity, the court finds ...........
(i) Regarding the depth of the relationship existing between the
child(ren) and present custodian, the court finds ...........
(j) Regarding the reasonable preferences and wishes of the
child(ren), if the court deems the child(ren) to be of sufficient intelligence,
understanding, and experience to express a preference, the court finds ...........
(k) Regarding the recommendations for the child(ren) provided
by the child(ren)’s guardian ad litem or the legal representative, the court
finds ...........
(l) Regarding other relevant factors including .........., the court
finds ...........
COMMENT: Add items 7, 8, and 9 as applicable.
7. Under section 39.811(6)(..........), Florida Statutes, the court
terminates the parental rights of only .....(parent whose rights are being
terminated)..... as to the minor child(ren), .....(child(ren)’s name(s))......
Specifically, the court finds that .....(specific findings of fact under section
39.811(6), Florida Statutes)......
8. Under sections 39.509(5) and 39.811(7)(a), Florida Statutes, the
court finds that continued grandparental visitation is not in the best interests
of the child(ren) or that such visitation would interfere with the permanency
goals for the child(ren) for the following reasons ...........
9. Under section 39.811(7)(b), Florida Statutes, the court finds that
although parental rights are being terminated, the best interests of .....(names
of child(ren) to which this provision applies)..... support continued
communication or contact by .....(names of parents, siblings, or relatives of the
parent whose rights are terminated and to which this provision applies).....
except as provided above. The nature and frequency of the communication or
contact shall be as follows ........... It may be reviewed on motion of any party or
an identified prospective adoptive parent.
THEREFORE, after weighing the credibility of the witnesses, weighing all
statutory factors, and based on the findings of fact and conclusions of law
above, the court hereby ORDERS AND ADJUDGES THAT:
1. The petition filed by .....(name)..... is granted as to the parent(s),
.....(name(s))......
2. The parental rights of the father, .....(name)....., and of the mother,
.....(name)....., to the child, .....(name)....., are hereby terminated under section
39.806(..........), Florida Statutes.
COMMENT: Repeat the above for each child and parent, as necessary.
3. Under sections 39.811(2) and (5), Florida Statutes, the child(ren),
.....(name(s)) ....., are placed in the custody of .....(agency)..... for the purpose of
subsequent adoption.
4. The 30-day permanency plan required by section 39.811(8),
Florida Statutes, shall be filed and heard at .....(time)..... on .....(date)..... in
.....(location)......
DONE AND ORDERED on .....(date)....., in .....(city and county).....,
Florida.
Circuit Judge
NOTICE
Under section 39.815, Florida Statutes, any child, any parent,
guardian ad litem, or legal custodian of any child, any other
party to the proceeding who is affected by an order of the
court, or the department may appeal to the appropriate District
Court of Appeal within the time and in the manner prescribed
by the Florida Rules of Appellate Procedure, which is 30 days
from the date this order is rendered (signed and filed). A parent
may have the right to a court-appointed attorney as provided
by law.
Under Florida Rule of Juvenile Procedure 8.530, a parent, who
had an attorney in the termination of parental rights
proceeding, shall have 20 days after this order terminating
parental rights is entered to file a motion in the trial court
claiming ineffective assistance of counsel. A parent does not
have the right to a court-appointed attorney to assist the
parent with a motion claiming ineffective assistance of
counsel, but the parent may independently obtain an attorney
to represent the parent in the motion. The motion must
contain the case name, case number, and identify the date the
written order terminating parental rights was entered. The
motion must also contain the current mailing address and e-
mail address, if any, and the phone number(s) of the parent
filing the motion for the purpose of receiving notices and
orders. In the motion, the parent must identify specific acts or
omissions in the attorney’s representation of the parent during
the termination proceedings that the parent claims constituted
a failure to provide reasonable, professional assistance, and the
parent must explain how the errors or omissions prejudiced the
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated.
Copies to:
FORM 8.9831. MOTION CLAIMING INEFFECTIVE ASSISTANCE
OF COUNSEL AFTER ORDER TERMINATING
PARENTAL RIGHTS
MOTION CLAIMING INEFFECTIVE ASSISTANCE OF COUNSEL
AFTER ORDER TERMINATING PARENTAL RIGHTS
Moving parent, .....(name)....., .....(address)....., .....(e-mail
address)....., .....(phone number)....., requests this court to vacate
the order terminating parental rights pursuant to Florida Rule of
Juvenile Procedure 8.530.
1. I was the parent of .....(name(s) of child(ren))..... at the
time the court entered an order terminating my parental rights on
.....(date)..... in .....(case number and case name)......
2. My attorney failed to provide me with reasonable,
professional assistance by doing or not doing the following actions
during the termination of parental rights proceedings: (use
whatever space is necessary to explain your claims)
Comment: The phrase “termination of parental rights
proceedings” is not limited to the termination of parental rights
trial.
3. My attorney’s actions or inactions prejudiced my case to
such an extent that my parental rights would not have been
terminated because: (use whatever space is necessary to explain
your claims)
WHEREFORE, I request that the court enter an order granting
this motion, vacating the order terminating parental rights, and
providing any other relief the court deems proper.
I understand that I am swearing or affirming under oath to the
truthfulness of the claims made in this verified motion and that
punishment for knowingly making a false statement includes fines
and/or imprisonment.
(Your signature)
I certify that a copy of this document was .....(mailed, faxed
and mailed, hand delivered, or e-mailed)..... to the person(s) listed
below on .....(date)..... or was not delivered to the person(s) listed
below because ...........
List each party or the party’s attorney who you served:
Name: ..........
Address: ..........
Telephone Number: ..........
Fax Number: ..........
E-mail Address: ..........
(Your signature)
FORM 8.9832. ORDER ON MOTION CLAIMING INEFFECTIVE
ASSISTANCE OF COUNSEL AFTER ORDER
TERMINATING PARENTAL RIGHTS
ORDER ON MOTION CLAIMING INEFFECTIVE ASSISTANCE OF
COUNSEL AFTER ORDER TERMINATING PARENTAL RIGHTS
THIS CAUSE came before this court on .....(date)..... on the
Motion Claiming Ineffective Assistance of Counsel after Order
Terminating Parental Rights filed by .....(name)...... Present before
the court were:
..... .....(Name)....., Moving Parent
..... .....(Name)....., Attorney for Moving Parent
..... .....(Name)....., Trial Attorney for Moving Parent
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Child
..... .....(Name)....., Attorney for Child
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other ..........
Comment: Complete the following section if the court denies the
motion without a hearing.
The court has carefully considered the motion and reviewed all
necessary documents. The court finds that the motion should be
denied without a hearing because:
..... The motion is untimely.
1. The order terminating parental rights was entered on
.....(date)......
2. The moving parent filed the motion claiming ineffective
assistance of counsel on .....(date)......
3. Therefore, the moving parent filed the motion past the
20-day time limitation.
..... The motion is insufficient as alleged. The court finds that the
moving parent failed to allege specific facts that, if taken as
true, would support a finding that the attorney during the
termination of parental rights proceedings failed to provide
reasonable, professional assistance, and that any errors or
omissions prejudiced the parent’s case to such an extent that
but for counsel’s deficient performance the rights of the parent
would not have been terminated. Specifically the court finds:
.....(findings)......
Comment: Complete the following section if the court finds that the
motion is insufficient and directs the moving parent to file an
amended motion.
The court has carefully considered the motion and reviewed all
necessary documents.
..... The motion is insufficient as alleged. The court finds that the
moving parent failed to allege specific facts that would support
a finding that the attorney during the termination of parental
rights proceedings failed to provide reasonable, professional
assistance, and that any errors or omissions prejudiced the
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated. Specifically the court finds: .....(findings).....
However, the court finds that the moving parent should be
provided the opportunity to file an amended motion.
Comment: Complete the following section if the court previously
found that the motion was insufficient, directed the moving parent
to file an amended motion, and the parent failed to file an amended
motion within the time permitted.
The court previously carefully considered the motion and
reviewed all necessary documents.
..... On .....(date)....., the court found the motion is insufficient as
alleged. The court found that the moving parent failed to allege
specific facts that would support a finding that the attorney
during the termination of parental rights proceedings failed to
provide reasonable, professional assistance, and that any
errors or omissions prejudiced the parent’s case to such an
extent that but for counsel’s deficient performance the rights
of the parent would not have been terminated. Specifically the
court found: .....(findings)......
..... On .....(date)....., the court entered a written order providing
the parent an opportunity to file an amended motion. The
parent did not file an amended motion within 10 days of the
date of the written order permitting amendment.
Comment: Complete the following section if the court hearing was
conducted:
The court has carefully considered the motion, reviewed all
necessary documents, and having heard argument of counsel and
testimony, the court finds:
..... The motion is granted because the attorney during the
termination of parental rights proceedings failed to provide
reasonable, professional assistance, and the errors or
omissions prejudiced the parent’s case to such an extent that
but for counsel’s deficient performance the rights of the parent
would not have been terminated. Specifically the court finds:
.....(findings)......
..... The motion is denied because the attorney during the
termination of parental rights proceedings did not fail to
provide reasonable, professional assistance, or any errors or
omissions that were made did not prejudice the moving
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated. Specifically, the court finds: .....(findings)......
THEREFORE, the court hereby ORDERS AND ADJUDGES THAT:
..... The motion claiming ineffective assistance of counsel is denied
with prejudice.
..... The motion claiming ineffective assistance of counsel is
insufficient as alleged. The moving parent may file an
amended motion. Any amended motion shall be filed within 10
days of the date of this order or the court may summarily deny
the motion.
..... The motion claiming ineffective assistance of counsel is
granted. The order terminating parental rights entered on
.....(date)..... is hereby vacated and set aside as to .....(name of
moving parent)...... An adjudicatory hearing is hereby
scheduled for .....(date (no later than 45 days from this
order))....., and, as the court finds the parent is indigent,
.....(name of counsel)..... is hereby appointed to represent
.....(name of moving parent)..... in the termination of parental
rights proceedings.
DONE AND ORDERED on .....(date)....., in .....(city and
county)....., Florida.
Circuit Judge
Copies to:
FORM 8.984. ORDER TERMINATING PARENTAL RIGHTS
(VOLUNTARY)
ORDER TERMINATING PARENTAL RIGHTS (VOLUNTARY)
THIS CAUSE came before this court on .....(all dates of the
adjudicatory hearing)..... for an adjudicatory hearing on the petition
for termination of parental rights filed by .....(name)...... Present
before the court were:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department/agency caseworker
..... .....(Name)....., Child
..... .....(Name)....., Attorney/Attorney ad litem for Child
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
..... The mother, .....(name)....., executed a voluntary
surrender of her parental rights for the minor child(ren),
.....(name(s))....., which is accepted by the court without objection.
COMMENT: Repeat the following as necessary.
..... The father, .....(name)....., executed a voluntary surrender
of his parental rights for the minor child(ren), .....(name(s)).....,
which is accepted by the court without objection.
The court has carefully considered the testimony of witnesses,
reviewed the exhibits, reviewed the file, heard argument of counsel,
and considered recommendations and arguments of all parties. The
court finds by clear and convincing evidence that the parents,
.....(names)....., have surrendered their parental rights to the minor
child(ren) under section 39.806(1)(a), Florida Statutes, and that
termination of parental rights is in the manifest best interests of the
child(ren). The specific facts and findings supporting this decision
are as follows:
1. That the mother, .....(name)....., ..... was ..... was not
personally served with the summons and the petition.
COMMENT: Service is not required if surrender was signed
before filing of petition.
2. That the father, .....(name)....., ..... was ..... was not
personally served with the summons and the petition.
COMMENT: Service is not required if surrender was signed
before filing of petition.
3. That the parents were advised of their right to counsel in
all prior dependency court proceedings which they attended. The
mother has been represented by legal counsel, .....(name).....,
starting on or about .....(date)..... The father has been represented
by legal counsel, .....(name)....., starting on or about .....(date)......
4. The mother, .....(name)....., freely, knowingly, voluntarily,
and ..... with ..... without advice of legal counsel executed an
affidavit and acknowledgment of surrender, consent, and waiver of
notice on .....(date)....., for termination of her parental rights to the
minor child(ren), under section 39.806(1)(a), Florida Statutes.
5. The father, .....(name)....., freely, knowingly, voluntarily,
and .....with ..... without advice of legal counsel executed an
affidavit and acknowledgment of surrender, consent, and waiver of
notice on .....(date)....., for termination of his parental rights to the
minor child(ren), under section 39.806(1)(a), Florida Statutes.
6. That at all times relevant to this action the interests of
this/these child(ren) has/have been represented by a guardian ad
litem. The guardian ad litem, .....(name)....., ..... agrees ..... does not
agree that it is in the best interests of the child(ren) for parental
rights to be terminated in this cause.
COMMENT: Guardian ad litem not required in voluntary
surrender.
7. Under the provisions of sections 39.810(1)–(11), Florida
Statutes, it is in the manifest best interests of the child(ren) for
parental rights to be terminated for the following reasons:
(a) Regarding any suitable permanency custody
arrangement with a relative of the child(ren), the court finds ...........
(b) Regarding the ability and disposition of the parent
or parents to provide the child(ren) with food, clothing, medical care
or other remedial care recognized and permitted under state law
instead of medical care, and other materials needs of the child(ren),
the court finds ...........
(c) Regarding the capacity of the parent or parents to
care for the child(ren) to the extent that the child(ren)’s safety, well-
being, and physical, mental, and emotional health will not be
endangered upon the child(ren)’s return home, the court finds
...........
(d) Regarding the present mental and physical health
needs of the child(ren) and such future needs of the child(ren) to the
extent that such future needs can be ascertained based on the
present condition of the child(ren), the court finds ...........
(e) Regarding the love, affection, and other emotional
ties existing between the child(ren) and the child(ren)’s parent or
parents, siblings, and other relatives, and the degree of harm to the
child(ren) that would arise from the termination of parental rights
and duties, the court finds ...........
(f) Regarding the likelihood of an older child remaining
in long-term foster care upon termination of parental rights, due to
emotional or behavioral problems or any special needs of the
child(ren), the court finds ...........
(g) Regarding the child(ren)’s ability to form a
significant relationship with a parental substitute and the likelihood
that the child(ren) will enter into a more stable and permanent
family relationship as a result of permanent termination of parental
rights and duties, the court finds ...........
(h) Regarding the length of time that the child(ren) has
lived in a stable, satisfactory environment and the desirability of
maintaining continuity, the court finds ...........
(i) Regarding the depth of the relationship existing
between the child(ren) and present custodian, the court finds
...........
(j) Regarding the reasonable preferences and wishes of
the child(ren), if the court deems the child(ren) to be of sufficient
intelligence, understanding, and experience to express a preference,
the court finds ...........
(k) Regarding the recommendations for the child(ren)
provided by the child(ren)’s guardian ad litem or the legal
representative, the court finds ...........
(l) Regarding other relevant factors including .........., the
court finds ...........
THEREFORE, it is ORDERED AND ADJUDGED that:
1. The petition for termination of parental rights is
GRANTED.
2. The parental rights of the father, .....(name)....., and of
the mother, .....(name)....., to the child(ren), .....(name(s))....., are
hereby terminated under section 39.806(..........), Florida Statutes.
COMMENT: Repeat the above for each child and parent on
petition.
3. The child(ren), .....(name(s))....., is/are hereby placed in
the permanent care and custody of .....(agency name)..... for
subsequent adoption.
4. A hearing for the department to provide a plan for
permanency for the child(ren) shall be held on .....(date)....., within
30 days of rendering of order, at .....(time)......
DONE AND ORDERED on .....(date)....., in .......... County,
Florida.
Circuit Judge
Copies to:
NOTICE
Under section 39.815, Florida Statutes, any child, any parent,
guardian ad litem, or legal custodian of any child, any other
party to the proceeding who is affected by an order of the
court, or the department may appeal to the appropriate District
Court of Appeal within the time and in the manner prescribed
by the Florida Rules of Appellate Procedure, which is 30 days
from the date this order is rendered (signed and filed). A parent
may have the right to a court-appointed attorney as provided
by law.
Under Florida Rule of Juvenile Procedure 8.530, a parent, who
had an attorney in the termination of parental rights
proceeding, shall have 20 days after this order terminating
parental rights is entered to file a motion in the trial court
claiming ineffective assistance of counsel. A parent does not
have the right to a court-appointed attorney to assist the
parent with a motion claiming ineffective assistance of
counsel, but the parent may independently obtain an attorney
to represent the parent in the motion. The motion must
contain the case name, case number, and identify the date the
written order terminating parental rights was entered. The
motion must also contain the current mailing address and e-
mail address, if any, and the phone number(s) of the parent
filing the motion for the purpose of receiving notices and
orders. In the motion, the parent must identify specific acts or
omissions in the attorney’s representation of the parent during
the termination proceedings that the parent claims constituted
a failure to provide reasonable, professional assistance, and the
parent must explain how the errors or omissions prejudiced the
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated.
FORM 8.985. MOTION TO TERMINATE SUPERVISION AND
JURISDICTION
MOTION TO TERMINATE SUPERVISION
AND JURISDICTION
The Department of Children and Family Services, by and
through its undersigned counsel, moves this court for an order
terminating the department’s supervision and the court’s
jurisdiction and closing the file in the above-styled cause, and as
grounds states:
1. The parental rights previously were terminated and the
child(ren) was/were permanently committed to the care and
custody of the department for adoption by order of this court.
2. The adoption was finalized on .....(date)......
WHEREFORE, the Department of Children and Family
Services requests that this court terminate jurisdiction and the
department’s supervision and that the file be closed.
.....(attorney’s name).....
.....(address and telephone
number).....
.....(Florida Bar number).....
Certificate of Service
FORM 8.986. ORDER TERMINATING SUPERVISION AND
JURISDICTION
ORDER TERMINATING SUPERVISION AND JURISDICTION
THIS CAUSE having come before the court on motion to
terminate supervision and jurisdiction filed by the Department of
Children and Family Services, and the court being otherwise
advised in the premises, find the following:
1. The parental rights previously were terminated and the
child(ren) was/were permanently committed to the care and
custody of the department for subsequent adoption by order of this
court.
2. The adoption was finalized on .....(date)......
THEREFORE, based on these findings of fact, it is ORDERED
AND ADJUDGED:
That the supervision of the Department of Children and
Family Services and this court’s jurisdiction are terminated.
DONE AND ORDERED on .....(date)......
Circuit Judge
Copies furnished to:
E. JUDICIAL WAIVER OF PARENTAL NOTICE OF
TERMINATION OF PREGNANCY FORMS
FORM 8.987. PETITION FOR JUDICIAL WAIVER OF PARENTAL
NOTICE AND CONSENT OR CONSENT ONLY TO
TERMINATION OF PREGNANCY
IN THE CIRCUIT COURT OF THE ………. JUDICIAL CIRCUIT
IN AND FOR …………… COUNTY, FLORIDA
In the Interest of …………… (pseudonym or initials of minor)
Case No.: ……….
Division: ……….
PETITION FOR JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION OF PREGNANCY
I certify that the following information is true and correct:
(1) The pseudonym or initials of the minor (is/are)
.................................., and the minor has filed a Sworn Statement
of True Name and Pseudonym with the clerk.
(2) The minor is ..... years old.
(3) The minor is pregnant and parental notice or consent has not
been waived.
(4) The minor requests that the court enter an order authorizing
her to terminate her pregnancy without
[check which applies]
………. notice to and consent from her parents or legal guardian
………. consent only from her parents or legal guardian
for one or more of the following reasons:
[check all that apply]
..... a. The minor is sufficiently mature to decide whether
to terminate her pregnancy, for the following reason(s):
…………………………………………………................
........................................................................................................
....................................................
..... b. The minor is a victim of child abuse or sexual abuse
inflicted by one or both of her parents or a legal guardian.
..... c. Notice and consent or consent only from a parent or
legal guardian is not in the best interests of the minor, for the
following reason(s):
………………………………………………….............................................
........................................................................................................
.......................................................................................
(5) The minor requests the appointment of an attorney to
represent her in this matter; and the attorney is appointed at no
costs to the minor at least 24 hours prior to hearing.
[check one]
..... Yes, I want an attorney to represent me during the
judicial waiver proceedings at no cost to me.
..... No, I do not wish to be represented by an attorney.
(6) The minor elects the following method or methods for receiving
notices of hearings or other court actions in this case (you may
choose more than one option):
[check all that apply]
..... Through a third party whose name is .................... and whose
address and phone number for purposes of notice are ....................,
.....................
..... The minor will contact the office of the clerk of court at the
following phone number .......................................
I understand that by signing this form I am swearing to or
affirming the truthfulness of the claims made in this petition and
that the punishment for knowingly making a false statement
includes fines, imprisonment, or both.
Signature:
Date: ..........
(You may sign a name other than your true name, such as
Jane Doe or other pseudonym under which your petition is being
filed.)
FORM 8.988. SWORN STATEMENT OF TRUE NAME AND
PSEUDONYM
SWORN STATEMENT OF TRUE NAME AND PSEUDONYM
NOTICE TO THE CLERK OF COURT: A CERTIFIED COPY OF THIS
DECLARATION WITH THE CASE NUMBER NOTED ON IT SHALL
BE GIVEN TO THE MINOR AFTER SHE SIGNS IT.
THE ORIGINAL SHALL IMMEDIATELY BE PLACED IN A SEALED
ENVELOPE WHICH SHALL BE FILED UNDER SEAL AND KEPT
UNDER SEAL AT ALL TIMES.
(1) My true name is , and my address is
.
(print your name) (print your
address)
(2) My date of birth is .
(3) I have filed a Petition for Judicial Waiver of Parental Notice
and Consent or Consent Only to Termination of Pregnancy under
the name or initials on .
(date)
I understand that by signing this form I am swearing to or affirming
the truthfulness of the information herein and that the punishment
for knowingly making a false statement includes fines,
imprisonment or both.
Dated: Signature:
(You must sign your true name.)
FORM 8.989. ADVISORY NOTICE TO MINOR
ADVISORY NOTICE TO MINOR
[Case No.: ....................]
YOU ARE NOTIFIED as follows:
YOUR CASE NUMBER APPEARS AT THE TOP OF THIS FORM.
KEEP IT IN A SAFE PLACE. YOU CAN NOT GET INFORMATION
FROM THE CLERK WITHOUT YOUR CASE NUMBER.
YOU HAVE BEEN GIVEN A COPY OF THE SWORN STATEMENT
YOU SIGNED WITH YOUR TRUE NAME. KEEP IT IN A SAFE
PLACE. YOU MAY NEED TO SHOW IT AND THE FINAL JUDGMENT
IN YOUR CASE TO YOUR DOCTOR BEFORE TERMINATING YOUR
PREGNANCY.
All information in your case is confidential. No papers will be sent
to your home, and you will be contacted by this court only through
the method you elected in the petition. Your name will not be on
your court papers.
If you would like an attorney to help you with your case, the court
will appoint one for you at no cost to you. Your attorney will receive
notices about your case so he or she can prepare for and attend
hearings with you. You may also name someone else you trust to
receive notices for you. You can also contact the clerk of court
yourself to check on your case.
You have a right to a hearing and a decision on your case within 48
hours of filing your petition unless you or your attorney waives this
right or asks for an extension of time. If this time limit is not met
you have the right to ask the clerk for a form that will allow your
doctor to perform a termination of pregnancy without notifying a
parent.
If the court dismisses your petition, you have the right to appeal.
You will be given information regarding how to proceed with an
appeal, and if you would like an attorney to help you with an
appeal, you may request that the court appoint one.
I certify that I have given a copy of this advisory form to the minor.
Dated:……….
Clerk of Court
……….County Courthouse
……….,Florida
FORM 8.990. FINAL ORDER GRANTING PETITION FOR
JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION
OF PREGNANCY
FINAL ORDER GRANTING PETITION FOR JUDICIAL WAIVER OF
PARENTAL
NOTICE AND CONSENT OR CONSENT ONLY TO TERMINATION OF
PREGNANCY
THIS CAUSE having come before the court on a petition for
judicial waiver of parental notice and consent or consent only to
termination of pregnancy and the court being otherwise advised in
the premises, finds the following:
..... The minor has proven by clear and convincing evidence that
she is sufficiently mature to decide whether to terminate her
pregnancy, for the following reason(s): …………………………
……………………………..………………………………………………………
………………………………………………………………………………………
………………………………
The court has considered the following factors in reaching this
decision that the minor is sufficiently mature to decide whether to
terminate her pregnancy and makes the following findings:
The minor’s age is ……….
The minor’s overall intelligence indicates
…………………………………………………………………….
The minor’s emotional development and stability indicates
………………………………………………….
The minor’s credibility and demeanor as a witness indicates
…………………………………………………
The minor’s ability to accept responsibility is demonstrated by
……………………………………………..
The minor’s ability to assess both the immediate and long-
range consequences of the minor’s choices is demonstrated by
………………………………………………………………………………………
The minor’s ability to understand and explain the medical
risks of terminating her pregnancy and to apply that understanding
to her decision is indicated by
………………………………………………………………….……………………
………………………………………………………………………………………
Whether there may be any undue influence by another on the
minor’s decision to have an abortion.
………………………………………………………………………………………
………………………………………………………………………………………
..... The minor has proven by a preponderance of the
evidence that she is a victim of child abuse or sexual abuse inflicted
by one or both of her parents or a guardian, for the following
reason(s):
……………………………….………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
The court, having made a finding under this section, will
report the abuse as is required by section 39.201, Florida Statutes.
..... The minor has proven by clear and convincing evidence
that ………. notice and consent or ………. consent only from a
parent or legal guardian is not in the best interests of the minor, for
the following reason(s):
…………………………………………………….…………………………………
………………………………………………………………………………………
………………………………………………………………………………………
……………………………………………
THEREFORE, it is ORDERED AND ADJUDGED that:
1. The petition for judicial waiver of parental ………. Notice
and consent or………. Consent only to termination of pregnancy is
GRANTED.
2. ……The minor may consent to the performance or
inducement of a termination of pregnancy without notice to a
parent or legal guardian.
……The minor may consent to the performance or inducement
of a termination of pregnancy but notice to a parent or legal
guardian must be provided.
3. The clerk shall keep and maintain a confidential record of
these proceedings as provided by law, and shall seal the record.
DONE AND ORDERED in the .......... court in and for …………
County, Florida, on .....(date)......
Judge
FORM 8.991. FINAL ORDER DISMISSING PETITION FOR
JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION
OF PREGNANCY
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
In the interest of Case no.
(pseudonym or initials of minor) Division:
FINAL ORDER DISMISSING PETITION FOR
JUDICIAL WAIVER OF PARENTAL NOTICE AND CONSENT OR
CONSENT ONLY TO TERMINATION OF PREGNANCY
THIS CAUSE having come before the court on a petition for
judicial waiver of parental notice and consent or consent only to
termination of pregnancy and the court being otherwise advised in
the premises, finds the following:
….. It was not proven by clear and convincing evidence that the
minor is sufficiently mature to decide whether to terminate the
pregnancy; specifically, the court has considered the following
factors in reaching this decision and makes the following findings:
The minor’s age is: ……….
The minor’s overall intelligence indicates:
…………………………………………….…………………………………
………….
…………………………………………….…………………………………
…………..
The minor’s emotional development and stability indicate:
…………………………………………….…………………………………
…………..
…………………………………………….…………………………………
…………..
The minor’s credibility and demeanor as a witness indicates:
…………………………………………….…………………………………
…………..
…………………………………………….…………………………………
………….
The minor’s ability to accept responsibility is demonstrated by:
…………………………………………….…………………………………
…………..
…………………………………………….…………………………………
…………..
The minor’s ability to assess both the immediate and long-
range consequences of the minor’s choices is demonstrated by:
…………………………………………….…………………………………
…………
…………………………………………….…………………………………
…………
The minor’s ability to understand and explain the medical
risks of terminating her pregnancy and to apply that
understanding to her decision is indicated by:
………………………………………………………………….……………
………………………………………………………………………………
……………………………
The minor’s decision to have an abortion may have been made
under any undue influence by another is indicated by:
…………………………………………….…………………………………
……………
…………………………………………….…………………………………
………….....
….. It was not proven by the preponderance of the evidence that
the petitioner is the victim of child abuse inflicted by one or both of
her parents or her legal guardian;
….. It was not proven by clear and convincing evidence that ……….
notification of and consent from OR ………. consent only from the
parent or legal guardian is not in the best interests of the petitioner;
….. Other:
THEREFORE, it is ORDERED AND ADJUDGED that:
1. The petition for judicial waiver of parental notice and
consent or consent only to termination of pregnancy is DISMISSED.
2. The court shall provide a written transcript of all
testimony and proceedings as provided by law.
3. The clerk shall keep and maintain a confidential record of
these proceedings as provided by law, and shall seal the record.
4. THE MINOR HAS A RIGHT TO APPEAL THIS
DECISION. The clerk shall immediately provide Form 9.900(f)
Notice of Appeal of an Order Dismissing a Petition for Judicial
Waiver of Parental Notice and Consent or Consent Only to
Termination of Pregnancy and Advisory Notice to Minor to the minor
or petitioner if other than the minor.
DONE AND ORDERED in the ........ court in and for ............
County, Florida, on .....(date)......
_________________________
_____
Judge
FORM 8.992. MINOR’S PETITION TO CHIEF JUDGE TO
REQUIRE A HEARING ON HER PETITION FOR
JUDICIAL WAIVER OF NOTICE AND CONSENT
OR CONSENT ONLY
MINOR’S PETITION TO CHIEF JUDGE TO REQUIRE A HEARING
ON HER PETITION
FOR JUDICIAL WAIVER OF NOTICE AND CONSENT OR CONSENT
ONLY
I, …..(name)….., hereby petition the chief judge of this judicial
circuit for an order directing the judge to whom this case is
assigned to hold a hearing within 48 hours after receipt of this
petition by the chief judge, and requiring the court to enter an order
on my petition for judicial waiver of notice and consent or consent
only within 24 hours after the hearing.
In support of this petition, I say:
My petition for judicial waiver of notice and consent or consent
only was filed with the Clerk on …..(date)……
The third business day from the date of filing my petition was
…..(date)……
I have not requested an extension of time for the hearing
required to be conducted.
No hearing has been conducted by the court within the time
required by statute.
WHEREFORE, I ask the chief judge to enter an order requiring
the hearing on the petition for judicial waiver to be conducted
within the next 48 hours, and requiring the court to enter its order
within 24 hours after that hearing.
Signature:
_____________________
Date:
_________________________
Time:
________________________
[to be stamped by
Clerk]
(a) Requirement to Attend School. If the court determines
that a student did miss any of the alleged days, the court shall
order the student to attend school and the parent, guardian, legal
custodian, or, if the student is in foster care, the case manager, to
ensure that the student attends school.
(b) Other Sanctions. If the court determines that a student
did miss any of the alleged days, the court may order any of the
following:
(1) The student to participate in alternative sanctions
to include mandatory attendance at alternative classes to be
followed by mandatory community service hours for up to six
months;
(2) The student or the student’s parent, guardian, or
legal custodian, to participate in homemaker or parent aid services;
(3) The student or the student’s parent, guardian, or
legal custodian to participate in and complete intensive crisis
counseling and/or community mental health services;
(4) The student and the student’s parent, guardian, or
legal custodian to participate in services provided by voluntary or
community agencies as available;
(5) The student or the student’s parent, guardian, or
legal custodian to participate in vocational, job training, or
employment services.
(c) Referral to Case Staffing Committee. If the student
does not successfully complete the sanctions ordered, the case shall
be referred to the case staffing committee, with a recommendation
to file a child in need of services petition under Chapter 984, Florida
Statutes.
(d) Participation by Parent, Guardian, Legal Custodian,
or Student. The parent, guardian, or legal custodian and the
student shall participate as ordered or required by the court, in any
sanction or services ordered pursuant to this rule.
(e) Enforcement by Contempt. The court shall enforce
such requirements through its contempt power, pursuant to
Chapter 984, Florida Statutes.
PART VI. FORMS FOR USE WITH RULES OF JUVENILE
PROCEDURE
The following forms are sufficient for the matters that are
covered by them. So long as the substance is expressed without
prolixity, the forms may be varied to meet the facts of a particular
case. Captions, verifications, and certificates of service, except for
the designation of the paper, are omitted from most forms. General
forms for these are provided at the beginning of the forms.
Publisher’s Note
The Florida Supreme Court’s per curiam opinion of December
24, 1980 (393 So.2d 1077) in which the forms appear provides:
“Nothing in the Forms shall be deemed to be a part of these Rules.”
Committee Note
1991 Amendment. These forms have been updated to
conform to revisions to Chapter 39, Florida Statutes, and the
Florida Rules of Juvenile Procedure. As the court has stated before,
the forms are not intended to be part of the rules and are provided
for convenience only.
A. GENERAL FORMS
FORM 8.901. CAPTION OF PLEADINGS AND ORDERS
NAME OF COURT
In the Interest of
...................., .....a child/children.....
.....(Designation of Pleading or Order).....
FORM 8.902. VERIFICATION
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared
.....(name)....., who, being sworn, says the .....(document)..... is filed
in good faith and on information, knowledge, and belief is true.
Sworn to and subscribed before me on .....(date)......
(Title)
Committee Notes
1991 Adoption. The above verification should be added to
petitions and motions as required by law.
FORM 8.903. CERTIFICATE OF SERVICE
I certify that a copy of .....(document)..... has been furnished to
.....(name(s))..... by .....e-mail/U.S. mail/hand delivery/fax..... on
.....(date)......
(Title)
Committee Notes
1991 Adoption. The above may be added to petitions, orders,
and other forms as required.
FORM 8.904. AFFIDAVIT FOR ORDER TO TAKE INTO
CUSTODY
AFFIDAVIT
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared affiant,
who, being sworn, made the following allegation of facts:
.................... and requested that the court issue an order to take
into custody the below.....named/described..... children.
Name(s) ……….
Age(s) ……….Sex ……….
Date(s) of Birth ……….
Race ……….
Address ……….
Identifying Description ……….
Parent/Custodian……….
Address ………..
Affiant
.....Address.....
FORM 8.905. ORDER TO TAKE INTO CUSTODY
ORDER TO TAKE INTO CUSTODY
TO: ……….
A .....verified petition/affidavit..... having been filed in this case,
alleging facts which under existing law are determined to be
sufficient to authorize taking into custody the below-
.....named/identified..... .....child/children....., believed to be of an
age subject to the juvenile jurisdiction of the circuit court; therefore
You are commanded to take the following .....child/children..... into
custody:
Name(s)……….
Age(s) ………. Sex ……….
Date(s) of Birth ……….
Race ……….
Address ……….
Identifying Description ……….
Parent/Custodian ……….
Address . ……….
For the following reasons:……….
Upon taking the .....child/children..... into custody, you will
deliver .....him/her/them..... to: ……….to be held pending a
.....detention/shelter..... hearing or upon further order of this court.
ORDERED in the circuit court in and for .................... County,
Florida, on .....(date)......
Circuit Judge
RETURN
This order to take into custody was executed at ..... m., on
.....(date)....., by the undersigned.
(Title)
RETURN TO ISSUING COURT UPON THE CHILD’S 19TH
BIRTHDAY
FORM 8.906. RELEASE ORDER
RELEASE ORDER
The court now finding that the above-named
.....child/children....., previously .....placed in shelter
care/detained....., should be released.
It is ADJUDGED:
1. That ……….shall be released immediately to ……….
2. It is FURTHER ADJUDGED that ………..
ORDERED in the circuit court in and for ……….County,
Florida, on .....(date)......
Circuit Judge
FORM 8.907. TRANSFER ORDER
TRANSFER ORDER
This case being before this court for consideration of transfer
to a court having juvenile jurisdiction in another county, the court
finds:
1. That on .....(date)....., following a hearing on the petition
of ...................., the court .....entered an order of
adjudication/withheld adjudication/accepted a plan of proposed
treatment, training, or conduct......
2. That it would be in the best interest of the above-named
.....child/children..... that this case be transferred to the circuit
court of another county because: ....................
3. That a dispositional order .....was/was not..... made in
this case.
It is recommended to the receiving court that: .....................
It is ADJUDGED:
1. That the jurisdiction of this court in this case and of the
.....child/children..... involved is transferred to the circuit court in
and for .................... County, Florida, of the ..... Judicial Circuit, for
any and all proceedings deemed necessary.
2. That within 5 days from the date of this order the clerk of
this court shall forward a certified copy of:
(a) The order of transfer, which shall include but not be
limited to:
(i) Specific offense that the child was found to have
committed;
(ii) Degree of offense;
(iii) Name of parent/custodian to be summoned;
(iv) Address at which the child should be summoned for
disposition;
(v) Name and address of the victim; and
(vi) Whether the child was represented by counsel.
(b) A certified copy of the delinquency petition;
(c) A copy of the juvenile referral or complaint; and
(d) Any reports and all previous orders including orders
appointing counsel entered by the court in the interest of that child.
These documents shall be forwarded to the clerk of the
receiving court; state attorney of the receiving court; public
defender of the receiving court, if counsel previously has been
appointed; and ……….
ORDERED in the circuit court in and for .................... County,
Florida, on .....(date)......
Circuit Judge
FORM 8.908. SUMMONS
SUMMONS
STATE OF FLORIDA
TO ...................., .....a child/children..... and ..................,
.....parent(s)/custodian.....:
A petition under oath has been filed in this court alleging the
above-named .....child/children..... to be .................... under the
laws of the State of Florida, a copy of which was attached hereto;
You are to appear before the Honorable ...................., Circuit
Judge, at .....m., on .....(date)....., at the county courthouse of
.................... County, at ...................., Florida for the hearing of
this petition. The .....parent(s)/custodian..... .....is/are..... required
to produce the .....child/children..... at that time and place unless
the .....child/children..... .....is/are..... in detention or shelter care at
that time.
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 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.
You may be held in contempt of court if you fail to appear.
WITNESS my hand and seal of this court at ....................
County, Florida, on .....(date)......
………., Clerk of Circuit Court
……….County, Florida
By: D.C.,
FORM 8.909. PLAN FOR TREATMENT, TRAINING, OR
CONDUCT
PLAN FOR TREATMENT, TRAINING, OR CONDUCT
TO: ………., Circuit Judge
Instead of a plea to the petition filed on .....(date)....., alleging
the above-named .....child/children..... to be ………., the following
proposed plan for treatment, training, or conduct, formulated in
conjunction with the supervising agency, is now submitted, with
the request that it be accepted by the court and that prosecution of
the said petition be deferred.
This agreement is entered into with full knowledge and
disclosure of all the facts and circumstances of this case, and in
consideration thereof, and the promise of fulfillment of its terms
and conditions, each of the undersigned agrees as follows: ……….
It is further agreed:
1. That the speedy trial rule is waived,
2. That a hearing for the acceptance of this plan .....is/is
not..... waived,
3. That this plan, as agreed to here, shall be in effect until
...............
In witness whereof the undersigned have affixed their hands
on .....(date)......
Child
.....Parent(s) or Custodian(s).....
Attorney for
.....Child/Parent(s)/Custodian(s).....
………., Department of Juvenile Justice, Supervising Agency,
Recommends: .....Acceptance/Rejection......
Authorized Agent
CONSENT IN DELINQUENCY CASES
The undersigned, being familiar with the contents of this plan
for treatment, training, or conduct and the delinquency petition on
which it is based, consents to defer prosecution of the petition.
Dated: ……….
……….
State Attorney
By:
Assistant State Attorney
ORDER
The foregoing plan for treatment, training, or conduct having
been properly submitted and having been given consideration by
the court,
It is ADJUDGED:
1. That the plan is approved and the parties thereto
shall comply with its terms and conditions.
2. That the plan is disapproved and an adjudicatory
hearing on the petition shall be scheduled.
ORDERED at ...................., .................... County, Florida, on
.....(date)......
Circuit Judge
FORM 8.911. UNIFORM CHILD CUSTODY JURISDICTION AND
ENFORCEMENT ACT AFFIDAVIT
See Fla. Sup. Ct. App. Fam. L. Form 12.902(d).
FORM 8.912. PETITION TO SHOW CAUSE
PETITION BY AFFIDAVIT FOR ORDERTO SHOW CAUSE
1. This is a proceeding for an order to show why the below-
named witness, ...................., should not be held in contempt of
court.
2. Petitioner is .....(title)......
3. A subpoena was duly served on .....(name)....., at
.....(time)..... by .....(name)..... who was then and there authorized to
serve said subpoena. A copy of the receipt evidencing service is
attached and incorporated by reference. Said .....(name)..... did not
appear on .....(date)....., at .....(time)..... in response to that
subpoena and to this date has not appeared.
WHEREFORE, the undersigned does respectfully request the
court to issue an order to direct .....(name)..... to appear before the
court to show cause why .....(name)..... should not be held in
contempt of court.
Petitioner
FORM 8.913. ORDER TO SHOW CAUSE
ORDER TO SHOW CAUSE
This cause came on to be heard on the petition for order to
show cause directed to .....(name)..... for failure .....(specify)..... on
.....(date)...... (See attached affidavit.)
NOW, THEREFORE, you, .....(name)....., are hereby ORDERED
to appear before this court located at ...................., on .....(date).....,
at .....(time)....., to show cause why you should not be held in
contempt of this court, for your failure to .....(specify)......
DONE AND ORDERED on .....(date)....., at ....................,
.................... County, Florida.
Circuit Judge
B. DELINQUENCY FORMS
FORM 8.929. DETENTION ORDER
DETENTION HEARING ORDER
Pick up order for absconding from:
..... supervised release
..... probation
..... commitment
..... other: ..................
Pick up order for:
..... violation of probation
..... violation of probation for an underlying felony firearm offense not
involving a new law violation
..... other: ..................
Present before the court:
..... the child;
..... .....(name)....., Assistant State Attorney;
..... .....(name)....., Assistant Public Defender/defense attorney;
..... .....(name)....., parent/legal guardian;
..... .....(name)....., DJJ juvenile probation officer;
..... .....(name)....., Department of Children and Family Services
..... .....(name)....., guardian ad litem
DJJ Supervision status:
..... None
..... Supervised release ..... with or ..... without an electronic monitor
..... Probation
..... Committed to ..... level
..... CINS/FINS
..... Conditional release
Other court involvement:
Dependency: ..... Yes ..... No ..... Unknown
Domestic relations: ..... Yes ..... No ..... Unknown
Domestic violence: ..... Yes ..... No ..... Unknown
The court finds that the child was taken into custody at ..... a.m./p.m.,
on .....(date)......
Probable cause that the child committed delinquent acts was:
..... found.
..... found for lesser included offense …...
..... not found.
..... reset within ….. hours of custody.
Risk assessment instrument (RAI) score: ..........
Score amended to: ..........
..... Meets detention criteria.
..... Meets detention criteria for being a Prolific Juvenile Offender.
IT IS ORDERED that the above-named child be:
..... released to the custody of .....(name)......
..... held in secure detention for domestic violence charge under section
985.255, Florida Statutes.
The court finds:
..... respite care is not available for the child; and
..... it is necessary to place the child in secure detention to protect the
victim from injury.
..... detained by the Department of Juvenile Justice in
..... supervised release.
….. days
..... supervised release with electronic monitoring.
..... supervised release with electronic monitoring due to being a
Prolific Juvenile Offender.
..... secure detention.
….. days
..... secure detention due to probable cause being found for a
designated offense and a risk to public safety and a danger
to the community.
with the following special conditions:
..... attend school regularly.
..... attend evaluation as follows:
..... physical.
..... psychological.
..... ADM.
..... other .....................
..... no (..... harmful) contact with .....(name)......
..... drug testing.
..... no drug and alcohol use.
..... other: ....................
Reasons for court ordering more or less restrictive placement than RAI
score:……….
It is FURTHER ORDERED that unless an adjudicatory hearing has begun or a
subsequent modification order is entered, the child must be released no later
than 5:00 p.m. on .....(date)..... to .....(name(s))....., who is/are
..... the parent(s)
..... a relative
..... foster care
..... ………. program
..... .....him/her..... self
..... other .....................
IT IS FURTHER ORDERED under section 985.039, Florida Statutes
..... The parent/guardian of the child, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL
32399-3100, $5 per day for each day the juvenile is in secure detention.
..... The parent/guardian of the child, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL
32399-3100, $1 per day for each day the child is on supervised release.
..... The parent/guardian of the child, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL
32399-3100, a REDUCED rate of $..... per day for each day the child is
in detention status. This reduced fee is based on the court’s finding
..... that the parent/guardian was the victim of the delinquent
act or violation of law for which the child is currently
detained and is cooperating in the investigation of the
offense; or
..... of indigency or significant financial hardship. The facts
supporting this finding are: ....................
..... The parent/guardian of the child, .....(name)....., .....(address)....., is liable
for .....% of the payment. The parent/guardian of the child, .....(name).....,
.....(address)....., is liable for .....% of the payment.
..... The .....supervision fee/cost of care..... is WAIVED based on the court’s
finding
..... that the parent/guardian was the victim of the delinquent act or
violation of law for which the child is currently detained and is
cooperating in the investigation of the offense; or
..... of indigency or significant financial hardship. The facts supporting
this finding are: ....................
If the child’s case is dismissed or if the child is found not guilty of the
charges or court order, then the parent/guardian is not liable for fees under
this order.
Unless modified by subsequent notice, the NEXT COURT APPEARANCE:
..... will be at .....(time)..... on .....(date)..... at .....(location).......
..... is to be set.
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.
Note: The child’s parent/legal guardian must advise Clerk’s Office and DJJ of
any address change.
..... Department of Juvenile Justice must transfer the child to ....................
Detention Center.
Other: ......................
DONE AND ORDERED in ................. County, Florida at ..........
a.m./p.m. on .....(date).....
Circuit Judge
Copies to: ....................
FORM 8.930. JUVENILE NOTICE TO APPEAR
JUVENILE NOTICE TO APPEAR
DATE .......... AGENCY ………..
CASE NO. ……….
PARENT, ADULT RELATIVE, LEGAL GUARDIAN .....(name).....
I am the .....(relationship to child)..... of .....(child’s name).....
and promise to ensure that the child appears on .....(date)..... at
.....(time)..... at .....(location)...... I also promise immediately to notify
the office of the state attorney at .....(telephone number)..... and the
clerk of the court at .....(telephone number)..... of any change in the
child’s address.
Signature of Parent/Adult
Relative/Legal Guardian
.....(address).....
.....(telephone number).....
.....(date).....
.....(address and telephone number
of child, if different).....
---------------
I, .....(child’s name)....., understand that I have been charged
with a law violation, .....(offense(s))....., and that I am being released
at this time to the custody of .....(parent, adult relative, or legal
guardian’s name)......
I promise to appear on .....(date)..... at .....(time)..... at
.....(location)....., and to appear as required for any additional
conferences or appearances scheduled by DJJ or the court. I
understand that my failure to appear shall result in a custody order
being issued and that I will be picked up and taken to detention.
Child’s Signature
Date ....................
Arresting Officer ....................
Releasing officer or DJJ
counselor authorizing release
DJJ Intake Telephone Number …………
ATTACH TO ARREST AFFIDAVIT
FORM 8.931. DELINQUENCY PETITION
PETITION
Your petitioner respectfully represents that ………. whose
date(s) of birth …. is/are ….. and who reside(s) at ………. ...is/ are
….. delinquent and that this court has jurisdiction of this cause
because of the following allegations of facts:……….
That the parents or custodians are:
…………………..
…………………….
Mother
Residence
…………………..
…………………….
Father
Residence
…………………..
…………………….
Custodian Residence
WHEREFORE, your petitioner requests process may issue to
bring the above-named parties before the court on a day and time
designated to be dealt with according to law.
Dated: ....................
Petitioner
FORM 8.932. APPLICATION FOR COUNSEL AND ORDER
APPLICATION FOR COUNSEL
AND ORDER
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared
affiant, who, being duly sworn, says:
1. That I understand a delinquency complaint has been
made against me and, being advised of my right to an attorney, now
request appointment of counsel.
2. Being without sufficient funds, property or assets of any
kind, I will be deprived of my right to representation unless I am
adjudged insolvent and counsel appointed to represent me.
3. That I have been informed that a lien for the value of the
legal services rendered to me by the public defender may be
imposed by law on any property I now or may hereafter have in this
state.
Dated: ....................
Affiant Child
STATEMENT OF PARENT(S)
The undersigned are informed and understand that liability for
cost of representation of this child by the public defender can be
assessed against the parent(s) by court order in an amount not to
exceed the amount provided by law.
Parent
Parent
ORDER
The court finds that this child is indigent, as defined by law,
and is desirous of counsel; it is, therefore,
ORDERED
1. That this child is declared to be insolvent.
2. That ...................., Public Defender for the ..... Judicial
Circuit, State of Florida, is hereby appointed as counsel to
represent this child in all matters in defense of the delinquency
complaint herein made.
DONE AND ORDERED in the circuit court in and for
.................... County, Florida, on .....(date)......
Circuit Judge
FORM 8.933. WAIVER OF COUNSEL
WAIVER OF COUNSEL
I GIVE UP MY RIGHT TO HAVE A LAWYER
1. I understand that a lawyer is a professional person who is
trained in the law and whose job it is to help people who have legal
problems.
2. I understand that if I have a lawyer, that person will do
several things to help me, such as:
a. Explaining the charges which have been filed against me in
the petition for delinquency.
b. Giving me advice on my rights and responsibilities in this
case.
c. Advising me as to what legal defenses may be available to
me.
d. Advising me as to whether or not I should challenge the
charges.
e. Helping me prepare my case for hearing if I decide to
challenge the charges.
f. Helping me get the proper witnesses to court.
g. Giving me advice and direction on what I should do
regarding my case.
3. I understand that I have a right to be represented by a
lawyer at any time and that if I cannot pay to hire a lawyer, the
judge will give one to me. In signing this paper, I understand that I
choose not to have a lawyer represent me at this time.
4. I understand that I keep the right to have a lawyer. I can
ask the judge at any time to give me a lawyer even if I have not
asked for one before.
5. A lawyer has explained to me my right to be represented in
this case, the results of not having a lawyer and other factors that
would help me to decide whether or not to have a lawyer in this
matter. I have had time to ask questions and have my questions
answered to my satisfaction, including questions about immigration
and other consequences.
6. I understand all of the above statements regarding my
rights to a lawyer but, I give up my right to be represented by a
lawyer at this time.
Date: ....................
Child Age
STATEMENT OF ATTORNEY ASSIGNED TO DISCUSS THE WAIVER
WITH THE CHILD
I have read this waiver to the child. I have explained the
waiver fully to the child and believe that the child has waived
counsel knowingly, intelligently, and voluntarily.
Date:……….
Attorney
FORM 8.934. ORDER TO DETERMINE MENTAL CONDITION
ORDER TO DETERMINE
MENTAL CONDITION
It having been made known to the court and the court finding
that reasonable grounds exist to believe that this child may be
incompetent to proceed with an adjudicatory hearing, and that a
hearing should be scheduled to examine this child and determine
.....his/her..... mental condition, it is
ADJUDGED:
1. That all proceedings in this case are now stayed, pending
further order of this court.
2. That a hearing to determine the mental condition of this
child is scheduled before me at ..... m., on .....(date)......
3. That the following named persons are hereby appointed
as disinterested qualified experts to examine this child as to
competency and to testify as to the child’s mental condition at the
hearing above scheduled:
(1) .....................................
.........................................................
Name Address
(2) .....................................
.........................................................
Name Address
(3) .....................................
.........................................................
Name Address
4. That this child shall be held temporarily in the custody of
...................., who shall produce the child for examination by the
above-named at a time and place to be arranged.
ORDERED at ...................., .................... County, Florida, on
.....(date)......
Circuit Judge
FORM 8.935. ORDER OF INCOMPETENCY
ORDER OF INCOMPETENCY
The above-named child being before the court for inquiry into
.....his/her..... mental condition and a determination of
.....his/her..... competency to proceed with an adjudicatory hearing,
from the evidence the court finds:
That the said child is mentally incompetent to proceed with
the adjudicatory hearing.
It is, therefore, ADJUDGED that proceedings shall be
commenced immediately for the involuntary hospitalization of this
child by ...................., as provided by law, and the said child shall
.................... pending disposition of those proceedings.
All proceedings in this case are stayed pending such action.
ORDERED at ...................., Florida, on .....(date)......
Circuit Judge
FORM 8.936. ORDER OF COMPETENCY
ORDER OF COMPETENCY
The above-named child being before the court for inquiry into
.....his/her..... mental condition and a determination of
.....his/her..... competency to proceed with an adjudicatory hearing,
from the evidence the court finds:
That the child is mentally competent to proceed with the
adjudicatory hearing.
It is, therefore, ADJUDGED that the adjudicatory hearing in
this case shall .....commence/resume..... at ..... m., on .....(date)......
ORDERED at ...................., Florida, on .....(date)......
Circuit Judge
FORM 8.937. DEMAND FOR VOLUNTARY WAIVER
DEMAND FOR VOLUNTARY WAIVER
OF JURISDICTION
The child files this demand for voluntary waiver of jurisdiction
pursuant to rule 8.105, Florida Rules of Juvenile Procedure, and
shows that the child desires the court to waive jurisdiction and
certify the case for trial in adult court as if the child were an adult
to face adult punishments or penalties.
Date: ....................
Child
Parent/Legal Guardian
FORM 8.938. ORDER OF VOLUNTARY WAIVER
VOLUNTARY WAIVER ORDER
Upon the demand for voluntary waiver filed by the child, it is
hereby ORDERED AND ADJUDGED as follows:
1. A demand for voluntary waiver of jurisdiction was filed by
the child and parent/legal guardian on .....(date)......
2. The court waives jurisdiction to try the child pursuant to
chapter 985, Florida Statutes.
3. The above cause is certified for trial as if the child were
an adult.
4. A certified copy of this order shall be furnished to the
clerk of the court having jurisdiction to try the child as an adult
and to the prosecuting officer of said child.
5. The child shall be forthwith delivered to the sheriff of the
county in which the court that is to try the child is located. Bond is
set at $...........
DONE AND ORDERED in chambers at ................,
.....(date)......
Circuit Judge
FORM 8.939. MOTION FOR INVOLUNTARY WAIVER
MOTION FOR INVOLUNTARY WAIVER
The State of Florida, having considered the recommendation of
the intake officer, petitions the court to waive jurisdiction pursuant
to rule 8.105, Florida Rules of Juvenile Procedure, and shows:
The child was 14 or more years of age at the alleged time of
commission of the violation of law for which the child is charged.
[Add the following paragraph, if applicable]
The child has been previously adjudicated delinquent for a
violent crime against a person, to wit .....(offense)....., and is
currently charged with a second or subsequent such offense.
Wherefore, the State of Florida requests the court to conduct a
hearing on this motion for the purpose of determining whether the
court should waive its jurisdiction and certify the case to the
appropriate court for trial as if the child were an adult.
Petitioner
FORM 8.940. MOTION TO COMPILE REPORT
MOTION TO COMPILE REPORT
The State of Florida, having filed a petition for involuntary
waiver, moves the court for an order requiring the department to
prepare a study and report to the court, in writing, considering the
following relevant factors:
1. The seriousness of the alleged offense to the community
and whether the protection of the community is best served by
transferring the child for adult sanctions.
2. Whether the alleged offense was committed in an
aggressive, violent, premeditated, or willful manner.
3. Whether the alleged offense was against persons or
against property.
4. The probable cause as found in the report, affidavit, or
complaint.
5. The desirability of trial and disposition of the entire
offense in one court when the child’s associates in the alleged crime
are adults or children who are to be tried as adults who will be or
have been charged with a crime.
6. The sophistication and maturity of the child.
7. The record and previous history of the child including:
a. Previous contact with the department, other law
enforcement agencies, and the courts;
b. Prior periods of juvenile probation;
c. Prior adjudications that the child committed a
delinquent act or violation of law, greater weight being given if the
child previously had been found by a court to have committed a
delinquent act involving an offense classified as a felony or had
twice previously been found to have committed a delinquent act
involving an offense classified as a misdemeanor; and
d. Prior commitments to institutions.
8. The prospects for adequate protection of the public and
the likelihood of reasonable rehabilitation of the child, if found to
have committed the alleged offense, by the use of procedures,
services, and facilities currently available to the court.
WHEREFORE, the State of Florida requests an order directing
the department to prepare a study and report in writing prior to the
waiver hearing.
Petitioner
FORM 8.941. ORDER TO COMPILE REPORT
ORDER TO COMPILE REPORT
Upon the motion of the State of Florida, the department shall
prepare a study and report to the court, in writing, considering the
following relevant factors:
1. The seriousness of the alleged offense to the community
and whether the protection of the community is best served by
transferring the child for adult sanctions.
2. Whether the alleged offense was committed in an
aggressive, violent, premeditated, or willful manner.
3. Whether the alleged offense was against persons or
against property.
4. The probable cause as found in the report, affidavit, or
complaint.
5. The desirability of trial and disposition of the entire
offense in one court when the child’s associates in the alleged crime
are adults or children who are to be tried as adults who will be or
have been charged with a crime.
6. The sophistication and maturity of the child.
7. The record and previous history of the child including:
a. Previous contact with the department, other law
enforcement agencies, and the courts;
b. Prior periods of juvenile probation;
c. Prior adjudications that the child committed a
delinquent act or violation of law, greater weight being given if the
child had previously been found by a court to have committed a
delinquent act involving an offense classified as a felony or had
twice previously been found to have committed a delinquent act
involving an offense classified as a misdemeanor; and
d. Prior commitments to institutions.
8. The prospects for adequate protection of the public and
the likelihood of reasonable rehabilitation of the child, if found to
have committed the alleged offense, by the use of procedures,
services, and facilities currently available to the court.
DONE AND ORDERED in chambers at ...................., Florida,
.....(date)......
Circuit Judge
FORM 8.942. ORDER OF INVOLUNTARY WAIVER
ORDER OF INVOLUNTARY WAIVER
A petition was filed in this cause on .....(date)...... Prior to the
adjudicatory hearing on the petition, the State of Florida filed a
motion requesting that the court waive its jurisdiction and certify
the case to the appropriate court for trial as if the child were an
adult. This cause came before the court on the motion.
The following were present .....(names)..... with .....(name).....,
representing the State of Florida and .....(name)....., representing
the Department of Juvenile Justice.
The court heard the evidence presented by the State of Florida
and the child to determine whether the jurisdiction of this court
should be waived and the case certified to the appropriate court for
trial as if the child were an adult. The court finds that it is in the
public interest that the jurisdiction of this court be waived and that
the case be certified to the appropriate court having jurisdiction to
try an adult who is charged with a like offense based on the
following findings of fact:
1. Age of child ..........
2. Seriousness of alleged offense ....................
3. Manner of commission of offense ....................
4. Nature of offense (person or property) ....................
5. Probable cause as found in the report, affidavit, or
complaint ....................
6. Desirability of trial and disposition of entire offense in
one court ....................
7. Sophistication and maturity of the child ....................
8. Record and previous history of the child ....................
9. Prospects for adequate protection of the public and
rehabilitation of child .............
IT IS ADJUDGED that the jurisdiction of this court is waived
and that this case is transferred to the .....(court)..... for trial as if
the child were an adult.
The child shall be held by the sheriff of this county unless a
bond in the amount of $.......... is posted. The child shall appear
before .....(court)..... on .....(date)..... to answer the State of Florida
on the foregoing charges.
DONE AND ORDERED in chambers at ...................., Florida,
on .....(date)......
Circuit Judge
FORM 8.947. DISPOSITION ORDER — DELINQUENCY
DISPOSITION ORDER
A petition was filed on .....(date)....., alleging .....(name)....., ….. age, to be
a delinquent child. The court finds that it has jurisdiction of the proceedings.
Present before the court were:
.....the child;
..... .....(name)....., Assistant State Attorney;
..... .....(name)....., Assistant Public Defender/defense attorney;
..... .....(name)....., guardian;
..... .....(name)....., DJJ juvenile probation officer.
At the hearing on .....(date)....., after ….. entry of a plea/an adjudicatory
hearing…..the child was found to have committed the delinquent acts listed
below:
Count Count Count Count
Charge .......... .......... .......... ..........
Lesser .......... .......... .......... ..........
Maximum .......... .......... .......... ..........
Degree .......... .......... .......... ..........
Guilty .......... .......... .......... ..........
Nolo contendere .......... .......... .......... ..........
Nolo prose .......... .......... .......... ..........
Adjudicated .......... .......... .......... ..........
Adj. withheld .......... .......... .......... ..........
The predisposition report was ..... received and considered/waived by the
child .....
The court, having considered the evidence and comments offered by
those present, having inquired, and being otherwise fully advised in the
premises ORDERS THAT:
..... Adjudication of delinquency is withheld.
..... The child is adjudicated delinquent……
..... The child is committed to a licensed child caring agency
..... The child is committed to the Department of Juvenile Justice for
placement in:
..... a moderate risk residential commitment program, for an
indeterminate period, but no longer than the child’s 21st birthday
or the maximum term of imprisonment an adult may serve for each
count listed above, whichever comes first, because
..... the child is before the court for a violation of section
790.22(3), Florida Statutes;
..... the child is before the court for the disposition of a felony;
..... the child has previously been adjudicated or had
adjudication withheld for a felony offense;
..... the child previously has been adjudicated or had
adjudication withheld for three or more misdemeanor
offenses within the previous 18 months;
..... the child is before the court for disposition for a violation of
sections 800.03, 806.031, or 828.12, Florida Statutes; or
..... the court finds by a preponderance of the evidence that the
protection of the public requires such placement or that the
particular needs of the child would be best served by such
placement. The facts supporting this finding are: ...........
..... a high-risk commitment program, for an indeterminate period, but
no longer than the child’s 21st birthday or the maximum term of
imprisonment an adult may serve for each count listed above,
whichever comes first.
..... a maximum-risk commitment program, for an indeterminate
period, but no longer than the child’s 21st birthday or the
maximum term of imprisonment an adult may serve for each count
listed above, whichever comes first, because the child meets the
criteria in section 985.465 or 985.494, Florida Statutes.
..... The child is allowed .......... days credit for time spent in secure detention
or incarceration before this date.
..... The child must be placed in secure detention until residential placement.
..... The court has orally pronounced its reasons for adjudicating and
committing this child.
..... The court retains jurisdiction to accept or reject the discharge of this
child from commitment, as provided by law.
..... The court orders that, following commitment, the child is to be:
..... directly discharged on release from commitment.
..... transitioned from a residential commitment program to a
conditional release program. Any period of conditional release may
not exceed the child’s 21st birthday or the maximum term of
imprisonment an adult could receive for each count listed above,
whichever comes first.
..... CONDITIONS OF CONDITIONAL RELEASE: On release from the
commitment program the child must abide by the following conditions
under section 985.46(5), Florida Statutes:
The Child must participate in an educational program if of a compulsory
school-attendance age under sections 1003.21(1) and (2)(a), Florida Statutes. If
the child is of a noncompulsory school-attendance age and has not received a
high school diploma or its equivalent, then the Child must participate in an
educational program or career and technical education course of study. If the
Child has received a high school diploma or its equivalent and is not employed,
then the Child must participate in workforce development or other career or
technical education or attend a community college or a university while in the
program.
1. The Child must have a curfew of ……
2. The Child is to have no contact with .....victims/co-
defendants/known gang members......
3. The Child must not use controlled substances.
4. The Child must not possess any firearms.
Other conditions:
…… The child was committed for an offense or attempted offense involving a
firearm and under section 985.433(7)(d), Florida Statutes, the child must
be placed on conditional release for a period of 1 year following release
from a commitment program. Conditional release must include electronic
monitoring of the child by the department for the initial 6 months
following release and at times and under terms and conditions set by the
department.
..... JUVENILE PROBATION: The child is ..... placed continued on..... juvenile
probation under supervision of .....the Department of Juvenile
Justice/.....(name)..... and
..... the court having withheld adjudication of delinquency, for an
indefinite period not to exceed the child’s 19th birthday.
..... the court having adjudicated the child delinquent, for an indefinite
period not to exceed the child’s 19th birthday or the maximum
term of imprisonment an adult could receive for each count listed
above, except for a second degree misdemeanor, six months,
whichever comes first.
..... as part of a sex offender treatment program, for an indefinite
period not to exceed the child’s 21st birthday or the maximum
term of imprisonment an adult could receive for each count listed
above.
..... Disposition on each count is .....concurrent/consecutive ......
..... This case disposition is ..... concurrent with/consecutive to.....case
number ...........
GENERAL CONDITIONS OF JUVENILE PROBATION. The child must abide by
all of the following conditions:
1. The child must obey all laws.
2. The child must be employed full-time or attend school with no
unexcused absences, suspensions, or disciplinary referrals.
3. The child must not change or leave .....his/her.... residence,
school, or place of employment without the consent of .....his/her..... parents
and juvenile probation officer.
4. The child must answer truthfully all questions of .....his/her.....
juvenile probation officer and carry out all instructions of the court and
juvenile probation officer.
5. The child must keep in contact with the juvenile probation officer
in the manner prescribed by the juvenile probation officer.
6. The child must not use or possess alcoholic beverages or controlled
substances.
SPECIAL CONDITIONS OF JUVENILE PROBATION. The child must abide by all
of the conditions marked below:
..... Restitution is ordered.
..... Parent(s) is/are responsible,
..... Child is responsible,
..... jointly and severally with ...........
..... The court reserves jurisdiction to determine the amount of restitution to
be paid.
..... $.......... to be paid to ..... (name) ….. Payments must begin .....(date).....
and continue at the rate of $ .......... each month.
..... Community Service. ..... hours are to be performed by the child at the
rate of ..... hours per month. Written proof is to be provided to the
juvenile probation officer.
..... A letter of apology to be written by the child to .....(name)….. within …..
days. The letter must be a minimum of ..... words.
..... A …… word essay to be written by the child on ..... (subject)…..and
provided to the juvenile probation officer within 30 days.
..... The child must have no ………. contact with victim(s), ..... (name(s)) ......
..... A ..... mental health/substance abuse .....evaluation to be completed by
the child within ….. days. The child will attend and participate in every
scheduled appointment and successfully attend and complete any and
all recommended evaluations and treatment.
..... A curfew is set for the child from .......... p.m. to .......... a.m. Sunday
through Thursday and from .......... p.m. to .......... a.m. Friday and
Saturday.
..... The child must submit to random urinalysis as instructed by the
Department of Juvenile Justice.
..... The child must submit to electronic monitoring by the Department of
Juvenile Justice.
..... The child must successfully complete all special conditions of juvenile
probation ordered in this case on .....(date)......
..... Other: ...........
..... The child must pay court costs of $ .........., as specified below.
The child is placed on notice that the court may modify the conditions of
.....his/her..... juvenile probation at any time and may revoke the juvenile
probation if the court finds there is a violation of the conditions imposed.
DRIVER LICENSE
..... The child’s driver license .....is suspended/is revoked/is
withheld/limitation is extended.....:
..... for .....(months/years)......
..... for a delinquent act involving the use or possession of a firearm,
under section 790.22, Florida Statute.
..... First offense, .....(up to one year)......
..... Second or subsequent offense, .....(up to two years)......
..... for a delinquent act involving the use or possession of a firearm
other than a violation of section 790.22, Florida Statutes, …..(up to
one year)…...
..... for a delinquent act under Chapter 893, Florida Statutes, ..... (up
to six months)......
FIREARM CHARGES
..... Having found the child committed a violation of section 790.22(3),
Florida Statutes, the child is ordered to serve:
..... for a first violation,
.......... days (up to 5), in the Juvenile Detention Center with credit
for .......... days served before disposition and
100 hours of community service or paid work as determined by the
Department.
or
..... for a second or subsequent violation,
.......... days (0 to 21), in the Juvenile Detention Center with credit
for .......... days served before disposition and
.......... hours (not less than 100 nor more than 250) of community
service or paid work as determined by the Department.
..... The court finds that the delinquent act in count .......... involves the use
or possession of a firearm other than a violation of section 790.22(3),
Florida Statutes, and the child is not committed by this order to a
residential commitment program of the Department of Juvenile Justice.
Therefore, under section 985.433(8), Florida Statutes, the child is
ordered to serve:
30 days in secure detention with .......... days credit for time served
before disposition,
100 hours of community service or paid work as determined by the
Department of Juvenile Justice, and
Juvenile Probation under the supervision of the Department of
Juvenile Justice for .......... (a minimum of 1 year).
FINES, FEES, AND COSTS:
..... The child must:
..... pay, notwithstanding the child’s present ability to pay, under
sections 938.27 and 985.032, Florida Statutes,
..... $50.00, per case (in disposition of every misdemeanor case),
the costs of prosecution,
..... $100.00, per case (in disposition of every felony case), the
costs of prosecution, or
..... $.......... to .....(agency)....., which, having claimed costs of
prosecution or investigation, as provided by law, has shown
to a preponderance its entitlement to such costs of
prosecution or investigation;
..... pay $.........., the Crimes Compensation Trust Fund fee, under
section 938.03, Florida Statutes;
..... pay $.........., the Teen Court cost and service charge, under section
938.19, Florida Statutes (if authorized by county ordinance);
..... pay $ .........., the Public Defender application fee, under section
27.52, Florida Statutes;
..... pay, notwithstanding the child’s present ability to pay, the Legal
Assistance Lien for payment of attorneys’ fees or costs, under
section 938.29, Florida Statutes,
..... $50.00, per case (in disposition of every misdemeanor case),
..... $100.00, per case (in disposition of every felony case), or
..... $.........., the court having found sufficient proof of higher
fees and costs incurred to .....(agency).....;
..... pay $.........., other costs, under section(s) .........., Florida Statutes.
..... The child has been adjudicated delinquent and the child must pay
$.........., an additional cost, under section 939.185, Florida Statutes, if
authorized by county ordinance.
..... The child has been adjudicated delinquent and assessed a fine and the
child must pay $.......... to the Crime Prevention Trust Fund, under
section 775.083(2), Florida Statutes.
..... The child has committed an enumerated crime against a minor and the
child must pay $ .........., under section 938.10, Florida Statutes.
..... The child has violated chapter 794, Florida Statutes (sexual battery), or
chapter 800, Florida Statutes, (lewdness; indecent exposure), and is
ordered to make restitution to the Crimes Compensation Trust Fund
under section 960.28(5), Florida Statutes, for the cost of the forensic
physical examination.
..... The child is unable to pay all court costs, and must perform ..........
hours of community service in place of these costs and fees.
SPECIMENS FROM THE CHILD
..... The child has entered a plea of guilty or nolo contendere to, or has been
found by this court to have committed, a delinquent act which is a felony
or an enumerated misdemeanor, and the child must submit specimens
under section 943.325, Florida Statutes.
ORDERS TO PARENTS/GUARDIANS
..... The parent(s) .....is/are.....
..... to complete.....counseling/parenting classes/community
service/restitution.....
..... participate with the child in .....court-imposed sanction/community
work project.....
..... Under section 985.039, Florida Statutes:
..... the parent/legal guardian, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive,
Tallahassee, FL 32399-3100, $5 per day for each day the child is
placed in secure detention or placed on committed status and the
temporary legal custody of the child is placed with the department.
..... the parent/legal guardian, .....(name).....,, must pay to the
Department of Juvenile Justice, 2737 Centerview Drive,
Tallahassee, FL 32399-3100, $1 per day for each day the child is
placed into non-secure detention, on probation, or other
supervision status with the department, or is committed to the
minimum risk nonresidential restrictiveness level commitment.
..... the parent/legal guardian, .....(name)....., must pay to the
Department of Juvenile Justice, 2737 Centerview Drive,
Tallahassee, FL 32399-3100, a REDUCED fee of $..... per day for
each day the child is in the custody of or supervised by the
department. This reduced fee is based on the court’s finding:
..... that the parent/legal guardian was the victim of the
delinquent act or violation of law for which the child is
currently before the court and is cooperating in the
investigation of the offense.
..... of indigency or significant financial hardship. The facts
supporting this finding are: ...........
..... The cost of care/supervision fee is WAIVED based on the court’s
finding:
..... that the parent/legal guardian was the victim of the
delinquent act or violation of law for which the child is
currently before the court and is cooperating in the
investigation of the offense.
..... of indigency or significant financial hardship. The facts
supporting this finding are: ...........
..... The parent/guardian, .....(name)....., .....(address)....., is liable for
..........% of the payment. The parent/guardian, .....(name).....,
.....(address)....., is liable for ..........% of the payment.
The parties are advised that an appeal is allowed within 30 days of the
date of this order.
DONE AND ORDERED in ..... (city) ....., .......... County, Florida on
.....(date) ....., at .......... a.m./p.m.
Circuit Judge
Copies to:
FORM 8.948. PETITION FOR REVOCATION OF JUVENILE
PROBATION
PETITION FOR REVOCATION OF
JUVENILE PROBATION
The petitioner represents to the court that ....................,
whose residence and address is .................... was adjudicated a
.................... child and placed on juvenile probation by order of this
court dated ...................., and that the child has violated the
conditions of the juvenile probation in a material respect by:
....................
The petitioner represents further that the parent(s) or
custodian(s) .....is/are.....:
…………………..
…………………….
Mother
Residence
…………………..
…………………….
Father
Residence
…………………..
…………………….
Custodian Residence
WHEREFORE, your petitioner requests that process may issue
to bring the above-named child before this court to be dealt with
according to law.
Date: ....................
Petitioner
FORM 8.949. ORDER FOR HIV TESTING
ORDER FOR HUMAN IMMUNODEFICIENCY
VIRUS (HIV) TESTING
The court having been requested by the .....victim/ victim’s
legal guardian/minor victim’s parent..... for disclosure of the child’s
HIV test results FINDS that:
The child, .....(name)....., .....is alleged by petition for
delinquency to have committed/has been adjudicated delinquent
for..... a sexual offense proscribed in chapter 794 or section
800.004, Florida Statutes, involving the transmission of body fluids
from one person to another.
It is ORDERED AND ADJUDGED that:
1. The child, .....(name)....., shall immediately undergo
Human Immunodeficiency Virus testing.
2. The testing shall be performed under the direction of the
Department of Health in accordance with section 381.004, Florida
Statutes.
3. The results of the test performed on the child pursuant to
this order shall not be admissible in any juvenile proceeding arising
out of the .....alleged sexual offense/sexual offense......
4. The results of the test shall be disclosed, under the
direction of the department, to the child and to the
.....victim/victim’s legal guardian/minor victim’s parent...... The
department shall ensure that the provisions of section 381.004,
Florida Statutes, for personal counseling are available to the party
requesting the test results.
DONE AND ORDERED at ...................., Florida, .....(date)......
Circuit Judge
FORM 8.950. RESTITUTION ORDER
JUDGMENT AND RESTITUTION ORDER
THIS CAUSE was heard on .....(date)....., on the state’s motion
for an order requiring the child, born .....(date)....., or .....his/her.....
parent(s), to pay restitution costs for the benefit of the victim
pursuant to sections 985.0301(5)(i), 985.437, and 775.089, Florida
Statutes.
Name of victim: ....................
Attorney or Advocate: ....................
Address: ....................
The court being fully advised in the premises, it is ORDERED
AND ADJUDGED:
The state’s motion is granted and the .....child/ child’s
parent(s), .....(name(s))....., shall pay restitution for the benefit of the
victim named above as follows:
..... $..... for medical and related services and devices relating to
physical, psychiatric, and psychological care, including nonmedical
care rendered in accordance with a recognized method of healing.
..... $..... for necessary physical and occupational therapy and
rehabilitation.
..... $..... to reimburse the victim for income lost as a result of the
offense.
..... $..... for necessary funeral and related services, if the offense
caused bodily injury resulting in the death of the victim.
..... $..... for damages resulting from the offense.
..... $..... for .....................
The total amount of restitution due is $......
Payment shall be made to the clerk of the circuit court.
Payment schedule:
..... Installment payments of $..... payable on a
.....weekly/monthly..... basis.
..... Payment is due in full.
..... The court finds that the .....child/child’s parent(s).....
.....is/are..... unable to pay and orders the child to perform .....
hours of community service in lieu of .....partial/total.....
restitution.
The court retains jurisdiction over this child beyond
.....his/her..... nineteenth birthday in order to enforce the
provisions of this order and retains jurisdiction to modify the
restitution in this case.
Other, specified conditions: ……….
IT IS FURTHER ORDERED AND ADJUDGED that the clerk of
the court shall provide the victim named above a certified copy of
this order for the victim to record this judgment as a lien, pursuant
to section 55.10, Florida Statutes.
IT IS FURTHER ORDERED AND ADJUDGED that this
judgment may be enforced by the state or the victim in order to
receive restitution in the same manner as a judgment in a civil
action. Execution shall issue for all payments required under this
order.
DONE AND ORDERED AT .....(city)....., .....(county)....., Florida,
on .....(date)......
Circuit Judge
Copies to:
State Attorney
Counsel for Child
Victim
Department of Juvenile Justice
Parent(s)
FORM 8.951. MOTION FOR JUVENILE SEXUAL OFFENDER
PLACEMENT
MOTION FOR JUVENILE SEXUAL
OFFENDER PLACEMENT
Comes now the .....State of Florida, by and through the
undersigned assistant state attorney/Department of Juvenile
Justice, by and through its undersigned counsel....., and moves the
court for Juvenile Sexual Offender placement. In support thereof,
movant would show:
..... that the juvenile has been found by the court, under section
985.35, Florida Statutes, to have committed a violation of chapter
794, chapter 796, chapter 800, section 827.071, or section
847.0133, Florida Statutes; or
..... that the juvenile has been found to have committed any
violation of law or delinquent act involving juvenile sexual abuse as
defined in section 985.475(1), Florida Statutes.
Placement in a juvenile sexual offender program is required for
the protection of the public and would best serve the needs of this
juvenile.
WHEREFORE, as this child meets the juvenile sexual offender
placement criteria, the .....state/ department..... respectfully
requests this court to enter an order placing the child as a juvenile
sexual offender under section 985.48, Florida Statutes.
Date: ....................
Assistant State Attorney/DJJ
Attorney
.....(address & phone no.).....
Florida Bar No.: ..........
FORM 8.952. FINDINGS FOR JUVENILE SEXUAL OFFENDER
REGISTRATION
REQUIRED FINDINGS FOR JUVENILE SEXUAL OFFENDER
REGISTRATION
The following findings are to be made for adjudications of
delinquency made on or after July 1, 2007, for committing, or
attempting, soliciting, or conspiring to commit any of the following
offenses, when the offender is 14 years of age or older at the time of
the offense.
Check the appropriate charge and make the corresponding findings:
Date of the offense: ....................
Offender’s age at date of offense: ....................
Victim’s age at date of offense: ....................
..... F.S. 794.011: Sexual Battery: Oral, anal, or vaginal
penetration by, or union with, the sexual organ of another, or the
anal or vaginal penetration of another by any other object.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense.)
….. F.S. 800.40(4)(b): Lewd or Lascivious Battery: Encouraging,
forcing, or enticing any person less than 16 years of age to
engage in sadomasochistic abuse, sexual bestiality, prostitution, or
any other act involving sexual activity.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense and at least one
of the lines below is checked “Yes.”)
Was the victim under the age of 12 at the time of the offense?
Yes ..... No .....
Did the sexual activity involve force or coercion? Yes ..... No
.....
..... F.S. 800.04(5)(d): Lewd or Lascivious Molestation – Victim
12-15: Intentionally touching the breasts, genitals, genital area,
buttocks, or the clothing covering them, of a person 12 years of
age or older but less than 16 years of age, or forcing or enticing a
person less than 16 years of age to so touch the perpetrator.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense and both boxes
below are checked “Yes.”)
Did the sexual activity involve unclothed genitals? Yes ..... No
......
Did the sexual activity involve force or coercion? Yes ..... No
.....
..... F.S. 800.04(5)(c): Lewd or Lascivious Molestation – Victim
under 12: Intentionally touching the breasts, genitals, genital
area, buttocks, or the clothing covering them, of a person less
than 12 years of age, or forcing or enticing a person less than 12
years of age to so touch the perpetrator.
(Sexual offender registration is required if the offender is 14
years of age or older at the time of the offense and the box
below is checked “Yes.”)
Did the sexual activity involve unclothed genitals? Yes ..... No
......
(Check one only)
SEXUAL OFFENDER REGISTRATION IS REQUIRED ......
SEXUAL OFFENDER REGISTRATION IS NOT REQUIRED ......
DONE AND ORDERED ON .....(date).....
Circuit Judge
FORM 8.953. WAIVER OF RIGHTS
WAIVER OF RIGHTS
1. Right to counsel.
I have the right to have a lawyer help me at all times while I
am in juvenile court. If I cannot afford a lawyer, the court will
appoint one to help me. The person next to me is a lawyer who can
help me.
I have talked to a lawyer about my case.
2. Entering a plea.
This means that I am not fighting the charge(s). It means that
I am entering a plea of guilty or no contest.
By pleading guilty, I am admitting that I did the crime(s) that
the state says I did.
By pleading no contest, I am entering a plea because it is in
my best interest, but I am not admitting that I did anything wrong.
3. Nature of the charge(s) against me.
I know the crime(s) I have been charged with and what they
mean.
I understand what crime(s) I am entering a plea to and which
ones (if any) the state will dismiss.
4. Constitutional Rights
By entering a plea, I am giving up the following constitutional
rights:
(a) Presumption of innocence.
Right now I am considered innocent and the state has to
prove that I am guilty or that I did what they say I did beyond a
reasonable doubt. I do not have to prove that I am innocent.
(b) Right to trial.
The state would try to prove I am guilty at a trial or
adjudicatory hearing. The state may use evidence such as witness
testimony, fingerprints, videos, or photos.
(c) Right to call and cross examine witnesses.
Witness testimony would be people who have information
about the crime that are required to come to the trial. They will
swear to tell the truth and answer questions by the prosecutor and
my lawyer. The state would ask the witnesses questions and my
lawyer and I would also be able to ask the witnesses questions.
I would also have the right to call my own witnesses at
trial to tell my side of the story and speak for me on my behalf.
(d) Right to testify on your own behalf.
I would also have the right to tell the judge my side of the
story after discussion with my lawyer.
(e) Right to remain silent.
I do not have to tell my side of the story. I can sit with
my lawyer and not say anything. My decision to not talk or present
evidence will not affect how the judge decides whether I am guilty or
not guilty.
5. Evidence and/or Defenses.
My lawyer has informed me of the facts that the state would
have to prove before I could be found guilty and has discussed with
me any possible defenses that could be used in my case. I am
entering this plea because I think the state could prove I am guilty
if we went to trial or because it is in my best interest.
6. Consequences of a Plea.
My lawyer, or the court, has informed me of the possible
consequences of entering into this plea, including, but not limited
to:
(a) loss of driver license;
(b) deportation issues;
(c) how this will affect my record and future
punishment from the court, including possible consequences in
adult court;
(d) how this affects my ability to get a job, join the
military, or apply for college;
(e) how this will affect my ability or my parent’s or
guardian’s ability to secure or maintain housing; and
(f) issues relating to sex offender registration and
notification as well as Jimmy Ryce consequences.
7. Voluntary and Intelligent.
I am entering this plea because I want to or because I think it
is in my best interest. No one is forcing me to enter this plea. No
promises or threats have been made to get me to enter this plea.
I am not under the influence of alcohol, drugs, or medications
at this time.
8. Appeal.
If I went to trial and the juvenile court judge decided that I was
guilty, I could ask some other judges, called appellate judges, to
look over the trial and decide if the trial was fair and if the decision
was fair and correct.
This is called my right to appeal. However, if the judge accepts
this plea, the only issues I will be able to appeal are those that
relate to my sentence and to the judge’s authority to hear my case.
I am presently represented by …..(name)…… My lawyer has
gone over all my rights and I am satisfied with the advice and help
of my lawyer.
Child Attorney for child Date
(print name) (print name)
C. DEPENDENCY FORMS
FORM 8.958. ORDER APPOINTING SURROGATE PARENT
ORDER APPOINTING SURROGATE PARENT
FOR DEPENDENT CHILD WHO HAS OR IS
SUSPECTED OF HAVING A DISABILITY
The court finds that:
1. The child has, or is suspected of having, a disability as
defined in the Individuals with Disabilities in Education Act
(“IDEA”) and F.S. 1003.01(3).
2. A surrogate parent is needed to act in the place of a
parent in educational decision-making and in safeguarding the
child’s rights under the IDEA.
3. The child is entitled, under the Individuals with
Disabilities in Education Act (“IDEA”), 20 U.S.C. §1415(b)(2); 34
C.F.R. §§300.515 and 303.406; F.S. 39.0016(3)-(4), 39.4085(17);
and Fla. Admin. Code 6A-6.0333, to the assistance of a surrogate
parent be-cause (check all that apply):
..... Parental rights have been terminated
..... Parents cannot be located
..... No parent is available to make education decisions
related to the child’s disability
..... Foster parent is unwilling or unable to make educational
decisions related to the child’s disability
..... Child resides in a group home or therapeutic foster home
..... Other: ....................
ACCORDINGLY, it is ORDERED that:
1. .....(Name)..... is appointed as a surrogate parent for
.....(child’s name)......
2. The surrogate parent named above has the following
rights, duties, and responsibilities:
a. to request or respond to requests for evaluations of
the child;
b. to review and keep confidential the child’s
educational records;
c. to request and participate in school meetings including
Individual Education Plan (IEP) meetings;
d. to express approval or disapproval of a child’s
educational placement or IEP;
e. to monitor the child’s educational development;
f. to help the child access available and needed
educational services;
g. to aid the child in securing all rights provided the
child under the IDEA;
h. to meet the child face-to-face
i. to be afforded all of the due process rights parents
hold under the IDEA
3. The surrogate parent may also do the following: (check all
that apply)
..... attend appropriate court hearings to address the
educational needs of the child. The surrogate parent will be
provided notice of all dependency court hearings.
..... attend dependency staffings. The community-based care
provider will invite the surrogate parent to all permanency staffings
and any other staffings when the child’s educational needs will be
addressed. See F.A.C. 65C-28.006.
..... ....................
..... ....................
4. As to issues affecting the provision of a Free Appropriate
Public Education, principals, teachers, administrators, and other
employees of the .......... County Public Schools shall communicate
with the surrogate parent and accept the requests or decisions of
the surrogate parent in the same manner as if he or she were the
child’s parent.
5. Unless the court explicitly orders otherwise, the
surrogate parent does not have the right and responsibility to
register the child in school, and grant or withhold consent for
ordinary school decisions not related to IDEA (such as field trips,
sports and club activities, medical care, etc.).
6. The surrogate parent must have access to and keep
confidential the child’s records including, but not limited to, records
from the school system, community-based care provider or agency,
and any mental health or medical evaluations or assessments.
7. By law, the surrogate parent has no liability for actions
taken in good faith on behalf of the child in protecting the special
education rights of the child.
ORDERED on .....(date)....., in .........., .......... County, Florida.
Circuit Judge
Copies to:
County Public Schools c/o Director, Exceptional Student
Education, Surrogate parent named above
(Check all that apply)
..... Attorney for DCF: .....(name).....
..... DCF caseworker: .....(name).....
..... Guardian ad Litem: ....(name).....
..... Attorney for mother: .....(name).....
..... Attorney for father: .....(name).....
..... Attorney for child: .....(name).....
..... Child named above .....(name).....
..... Foster parent: .....(name).....
..... Relative caregiver: .....(name).....
..... Child’s principal: .....(name)..... at ................... School
..... Other: ....................
..... Other: ....................
FORM 8.959. SUMMONS FOR DEPENDENCY ARRAIGNMENT
SUMMONS AND NOTICE OF HEARING
STATE OF FLORIDA
TO: .....(name and address of person being summoned).....
.....(Petitioner’s name)..... has filed in this court a
petition, alleging under oath that the above-named child(ren) is/are
dependent under the laws of the State of Florida and requesting
that a summons issue in due course requiring that you appear
before this court to be dealt with according to law. A copy of the
petition is attached to this summons.
You are to appear before this Court at .....(location of
hearing)....., at .....(time and date of hearing)......
FAILURE TO APPEAR AT THE ARRAIGNMENT HEARING
CONSTITUTES CONSENT TO THE ADJUDICATION OF THIS
CHILD (OR CHILDREN) AS A DEPENDENT CHILD (OR
CHILDREN) AND MAY ULTIMATELY RESULT IN LOSS OF
CUSTODY OF THIS CHILD (OR CHILDREN).
IF YOU FAIL TO APPEAR YOU MAY BE HELD IN CONTEMPT OF
COURT.
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 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.
Witness my hand and seal of this court at .....(city, county,
and state)....., on .....(date)......
CLERK OF COURT
BY:
DEPUTY CLERK
CITATORIO Y AVISO DE AUDIENCIA
ESTADO DE FLORIDA
PARA: ..... (nombre y dirección de la persona citada).....
..... (Nombre del peticionario)..... ha presentado en este
tribunal una petición, alegando bajo juramento que los niños
mencionados anteriormente son dependientes según las leyes del
Estado de Florida y solicitando que se emita un citatorio a su
debido tiempo que requiera que comparezca ante este tribunal para
ser tratado de acuerdo con la ley. Se adjunta copia de la petición a
este citatorio.
Deberá comparecer ante este Tribunal en ..... (lugar de la
audiencia)....., en ..... (hora y fecha de la audiencia)......
NO COMPARECER EN LA AUDIENCIA DE TUTELA CONSTITUYE
UN CONSENTIMIENTO PARA LA ADJUDICACIÓN DE ESTE NIÑO
(O NIÑOS) COMO HIJO (O HIJOS) DEPENDIENTE(S) Y, EN
ÚLTIMA INSTANCIA, PUEDE RESULTAR EN LA PÉRDIDA DE LA
CUSTODIA DE ESTE NIÑO (O NIÑOS).
SI NO SE PRESENTA, PUEDE SER DECLARADO EN DESACATO AL
TRIBUNAL.
COMENTARIO: El siguiente párrafo debe estar en negrita, 14 pt.
fuente Times New Roman o Courier.
Si usted es una persona con una discapacidad que necesita
alguna adaptación para participar en este procedimiento, tiene
derecho, sin costo alguno para usted, a que se le provea de
cierta asistencia. Póngase en contacto con ..... (nombre,
dirección, número de teléfono)..... al menos 7 días antes de su
comparecencia programada ante el tribunal, o inmediatamente
después de recibir esta notificación si el tiempo antes de la
comparecencia programada es inferior a 7 días. Si tiene
problemas de audición o de voz, llame al 711.
Doy fe con mi firma y sello de este tribunal en..... (ciudad, condado
y estado)....., en ..... (fecha)......
SECRETARIO DEL TRIBUNAL
POR: _________________________
SECRETARIO ADJUNTO
MANDA AK AVÈTISMAN POU YON CHITA TANDE
LETA FLORID
POU: ....(non ak adrès pou moun yo voye manda-a)......
kÒm, tantiske, .....(non pati ki fé demann-nan).... fé yon
demann devan tribinal-la, epi li sèmante timoun-nan(yo), swa dizan
bezwen pwoteksyon leta dapre règ lalwa nan Leta Florid, yon kopi
enfòmasyon sou akizasyon-an kwoke nan lèt sa-a. Yo mande pou yo
sèvi-w ak yon manda touswit, ki pou fose-w prezante devan tribinal
la pou yo ka koresponn avèk ou, dapre lalwa.
Alò, pou sa yo kòmande-w pou prezante devan tribinal sa-a, ki
nan ....., (adrès tribinal-la) ......, a .... (nan dat ak lè, chita tande-a)
.....
SI OU PA PREZANTE NAN CHITA TANDE-A, POU YO KA AVÈTI-
W AK AKIZASYON OFISYÈL-LA, SA KA LAKÒZ YO DESIDE OU
KON-SANTI TIMOUN-NAN(YO), BEZWEN PWOTEKSYON LETA,
EPI LI KA LAKÒZ OU PÈDI DWA-OU KÒM PARAN TIMOUN SA-
A(YO).
SI OU PA PREZANTE, YO GEN DWA CHAJE-W, KÒMKWA OU
MANKE TRIBINAL LA DEGA.
Si ou se yon moun infirm, ki beswen `ed ou ki bewsen ke o
akomode w pou ou patispe nan pwosedi sa yo, ou genyen dwa,
san ke ou pa peye, a setin `ed. Silvouple kontake …..(non,
address, telephone)….. o moin 7 jou avan dat ou genyen
rendevou pou ale nan tribunal, ou si le ou resevwa avi a, genyen
mouins ke 7 jou avan date endevou tribunal la. Ou si ou pa
tande pale, rele nan nimerro sa 711.
Mwen siyen non mwen, epi mete so mwen, nan dokiman
tribinal-la sa-a, kòm temwen, nan (vil, distrik, eta) ...., nan ....
(dat).....
GREFYE TRIBINAL-LA
PA:
ASISTAN GREFYE TRIBINAL-LA
FORM 8.960 SHELTER PETITION
AFFIDAVIT AND PETITION FOR PLACEMENT IN SHELTER
COMES NOW, the undersigned, who being first duly sworn
says:
1. On .....(date)..... at .......... a.m./p.m. the above named
minor child(ren) was/were found within the jurisdiction of this
court.
..... The child(ren) was/were taken into custody by ...........
..... The child(ren) need(s) to be taken into protective custody.
2. The name, age, special needs, and residence of this/these
child(ren) is/are:
Birth Special
Name date Sex Needs Address
....................... ................... ................ .......................
.......................
....................... ................... ................ .......................
.......................
....................... ................... ................ .......................
.......................
3. The name, relationship to the child(ren), and address of
the child(ren)’s parents or other legal custodian(s) is/are:
Name Relationship Address
..................... ..................... .....................
..................... ..................... .....................
4. The following individuals who were listed in #3 above
have been notified in the following manner of the date, time, and
location of this hearing:
Name Manner Notified
…………………………………
………………………………….
…………………………………
………………………………….
…………………………………
………………………………….
5. There is probable cause that the child(ren)
..... a. has/have been abused, abandoned, or neglected ort
is/are in imminent danger of illness or injury as a result of abuse,
abandonment, or neglect;
..... b. was/were with a parent or legal custodian who has
materially violated a condition of placement imposed by the court;
..... c. has/have no legal custodian, or responsible adult relative
immediately known and available to provide supervision and care;
because ...........
6. The provision of appropriate and available services will
not eliminate the need for placement of the child(ren) in shelter care
because:
..... a. an emergency existed in which the child(ren) could not
safely remain in the home;
..... b. the home situation presents a substantial and immediate
danger to the child(ren) which cannot be mitigated by the provision
of preventive services;
..... c. the child(ren) could not be protected in the home despite
the provision of the following services and efforts made by the
Department of Children and Families to prevent or eliminate the
need for placement in shelter care;
..... d. the child(ren) cannot safely remain at home because
there are no preventive services that can ensure the safety of the
children.
7. The department has made reasonable efforts to keep the
siblings together after the removal from the home. The reasonable
efforts of the department were ..........
..... a. The children are currently placed together ...........
..... b. A foster home is not available to place the siblings
together because ...........
..... c. It is not in the best interest of each child that all the
siblings be placed together in out-of-home care because ...........
8. On-going visitation or interaction between the siblings
.....(list)..... is
..... a. recommended as follows ...........
..... b. not recommended because visitation or interaction would
be contrary to the safety or well-being of .....(name(s))..... because
...........
9. The child(ren) is/are in need of and the petitioner
requests the appointment of a guardian ad litem.
10. The petitioner requests that the parents, if able, be
ordered to pay fees for the care, support, and maintenance of the
child(ren) as established by the department under chapter 39,
Florida Statutes.
11. The petitioner requests that the parents be ordered to
provide to the Department of Children and Families and the
Department of Revenue financial information necessary to
accurately calculate child support under section 61.30, Florida
Statutes, within 28 days of this order.
12. This affidavit and petition is filed in good faith and under
oath.
WHEREFORE, the affiant requests that this court order that
this/these child(ren) be placed in the custody of the department
until further order of this court and that the place of such custody
shall be:
..... at the discretion of the Department of Children and Families;
..... at the home of a responsible adult relative, .....(name).....,
whose address is ...............;
..... other.
Moving Party
.....(attorney’s name).....
.....(address and telephone
number).....
E-mail address: ..........
Florida Bar number: ..........
Verification
NOTICE TO PARENTS/GUARDIANS/LEGAL CUSTODIANS
A date and time for an arraignment hearing is normally set at
this shelter hearing. If one is not set or if there are questions, you
should contact the Juvenile Court Clerk’s Office at ........... A copy of
the Petition for Dependency will be given to you or to your attorney,
if you have one. A copy will also be available in the clerk’s office.
You have a right to have an attorney represent you at this hearing
and during the dependency proceedings and an attorney will be
appointed for you if you request an attorney and the court finds
that you are unable to afford an attorney.
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 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.
FORM 8.961. SHELTER ORDER
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
FORM 8.961(A). ORDER AUTHORIZING ACCESS TO CHILD’S
MEDICAL AND EDUCATIONAL RECORDS
ORDER AUTHORIZING ACCESS TO CHILD’S MEDICAL
AND EDUCATIONAL RECORDS
THIS CAUSE came on to be heard under sec. 39.402, Florida
Statutes, concerning access to the medical and educational records
of ...................., a child.
The Court finds
A. As to medical records and information:
..... ...................., mother/father of ..................., the child,
consents to the entry of this order, and to the court’s providing
access to the child’s medical records to the department, its contract
agencies, and any guardian ad litem and attorney for the child, and
to provide the child’s medical information to the court.
..... No parent or legal guardian of the child is available or
able to consent to the entry of this order, or the parents withhold
consent to providing access to the child’s medical records and/or to
providing the requested medical information.
..... Access to the child’s medical records and information is
necessary to provide services to the child.
B. As to educational records and information.
..... ...................., mother/father of ...................., the child,
consents to the entry of this order, and to the court’s providing
access to the child’s educational records to the department, its
contract agencies, and any guardian ad litem and attorney for the
child, and to provide the child’s educational information to the
court.
..... No parent or legal guardian of the child is available or
able to consent to the entry of this order, or the parents withhold
consent to providing access to the child’s educational records
and/or to providing the requested educational information.
..... Access to the child educational records and information
is necessary to provide services to the child.
Therefore, it is ORDERED
The department, .....(name of CBC)....., its contract agencies,
.....(name)....., guardian ad litem, and .....(name)....., attorney for
child, are authorized to access .....(child’s name).....’s medical and
educational records and information, until further order of this
court.
..... This order does not address the child’s privacy rights to
any of these records or information that may exist under Florida
law. The child may assert to this court any objection under privacy
rights to the release of this information
ORDERED on .....(date)....., in .........., .......... County, Florida
Circuit Judge
Copies to:
(Check all that apply)
..... Attorney for DCF: .....(name).....
..... Caseworker: .....(name).....
..... Guardian ad litem: .....(name).....
..... Attorney for mother: .....(name).....
..... Attorney for father: .....(name).....
..... Attorney ad litem for child: .....(name).....
..... Child named above: .....(name).....
..... Other: ....................
..... Other: ....................
FORM 8.964. DEPENDENCY PETITION
PETITION FOR DEPENDENCY
COMES NOW, Petitioner, .....(name)....., by and through
undersigned counsel, and petitions this court to adjudicate the
above-named minor child(ren) to be dependent within the meaning
and intent of chapter 39, Florida Statutes. As grounds, petitioner
alleges the following:
1. This court has jurisdiction over the minor child(ren),
.....(name(s))....., a .....(gender)..... child, whose date(s) of birth is/are
.........., and who, at the time the dependency arose, was/were in
the custody of .....(name(s))......
2. The natural mother of the minor child(ren) is
.....(name)....., a resident of .....(state)....., whose address is ………..
3. The father of the minor child(ren), .....(name(s))..... is
.....(name)....., whose address is ……….. The father ..... is ..... is not
married to the mother, and ..... is ..... is not listed on the child(ren)’s
birth certificate(s). The mother filed a Sworn Statement About
Identity or Location of Father with this court on .....(date)....., which
named ………. as the father.
4. The UCCJEA Affidavit ..... is attached ..... was filed with
the Court on .....(date)..... and is incorporated by reference.
5. The child(ren) is/are dependent within the meaning and
intent of chapter 39, Florida Statutes, in that the
mother/father/parents/legal custodian/caregiver(s) abused,
abandoned, or neglected the minor child(ren) on or about
.....(date)....., by: .................... and that these activities and
environments cause the child(ren)’s physical, mental, or emotional
health to be in danger of being significantly impaired.
OR
5. The above named child(ren) is/are presently under
substantial risk or imminent threat of harm or abuse or neglect,
within the meaning and intent of chapter 39, Florida Statutes,
which is likely to cause the child(ren)’s physical health to be
significantly impaired because .....................
6. The department is unable to ensure the protection of the
minor child(ren) without judicial intervention.
7. The mother/father/parents has/have received the
following services: .....................
8. A shelter hearing was held on .....(date)....., and the
child(ren) was/were placed in the custody of .....................
9. An arraignment hearing
..... needs to be scheduled.
..... is scheduled for .....(date and time)......
10. A guardian ad litem
..... needs to be appointed.
..... was appointed at the shelter hearing to represent
the child(ren).
11. .....(name of child(ren))..... has/have special needs as
defined in Chapter 39, Florida Statutes. An attorney:
..... needs to be appointed.
..... has been appointed.
12. Under chapter 39, Florida Statutes, the clerk of the court
is required to issue a summons to the following parents or
custodians:
The natural mother, .....(name)....., whose address is
.....................
The natural father, .....(name)....., whose address is
.....................
.....(Additional fathers and their addresses)......
WHEREFORE, the petitioner asks that process may issue in
due course to bring the above-named parties before the court to be
dealt with according to the law, to adjudicate the named minor
child(ren) named to be dependent.
….(Petitioner’s name)……
…… (Attorney’s name)…..
….. (address and telephone number)
Florida Bar Number:……….
Verification
Certificate of service
NOTICE OF RIGHTS
PLEASE READ THIS PETITION BEFORE ENTERING THE
COURTROOM.
YOU HAVE A RIGHT TO HAVE COUNSEL PRESENT AT THIS
HEARING.
BY COPY OF THIS PETITION, THE PARENTS, CAREGIVERS,
AND/OR LEGAL CUSTODIANS ARE NOTIFIED OF THEIR RIGHT
TO HAVE LEGAL COUNSEL PRESENT FOR ANY PROCEEDING
RESULTING FROM THIS PETITION OR TO REQUEST THE
COURT TO HAVE COUNSEL APPOINTED, IF INDIGENT.
Further, these persons are informed of the following:
An arraignment is set on this matter for .....(date)....., at
..... a.m./p.m., at .....(location)...... The purpose of the
arraignment is to advise as to the allegations contained in the
Petition For Dependency. When your case is called, the Judge
will ask you to enter a plea to this petition. The plea entered
may be one of the following:
1. Admit: This means you admit that the petition states
the truth and you do not want a trial.
2. Consent: This means you neither admit nor deny the
petition, but do not want a trial.
(If you enter either of the above two pleas, the court will
set a disposition date for the matter. At disposition, the court
will decide where the child will stay and under what
conditions).
3. Deny: This means you deny the allegations of the
petition and wish the state to attempt to prove them at a trial.
4. Continue: This means you wish time to confer with
an attorney, before entering a plea. If you enter this plea, the
court will schedule another hearing in approximately 2 weeks.
At that time, another arraignment hearing will be held, and you
(or your attorney) must enter one of the above three pleas.
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, and 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.
FORM 8.965. ARRAIGNMENT ORDER
ORDER ON ARRAIGNMENT AND
NOTICE OF NEXT HEARING
THIS CAUSE came to be heard on .....(date)....., under chapter
39, Florida Statutes, on the Petition For Dependency filed by
.....(name)....., for arraignment of .....(name(s))...... The following
persons appeared before the Court:
….. ….. (Name)….., Petitioner
….. ….. (Name)….., Attorney for the petitioner
….. ….. (Name)….., Attorney for the department
….. ….. (Name)….., Department caseworker
….. ….. (Name)….., Mother
….. ….. (Name)….., Attorney for the mother
….. ….. (Name)….., Father of …..(child)…..
….. ….. (Name)….., Attorney for father
….. ….. (Name)….., Guardian ad litem
….. ….. (Name)….., Attorney for guardian ad litem
….. ….. (Name)….., Attorney/Attorneys for …..Child/Children…..
….. ….. (Name)….., Legal custodian
….. ….. (Name)….., Attorney for legal custodian
….. ….. (Name)….., 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.
The court having considered the Petition for Dependency and
having heard testimony and argument, and having been otherwise
duly advised in the premises finds:
1. This court has jurisdiction over the subject matter of this
action; and
2. The mother, …… (name)…..:
….. was …..not noticed of this hearing
…..did not appear, and the court:
….. entered a consent by default
…… did not enter a consent by default;
….. appeared with counsel….. appeared without counsel and:
….. was….. was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily, …..waived
……did not waive her right to legal counsel; and
……was ….. was not determined to qualify as indigent
and….. was ….. was not appointed an attorney.
..... was served with a petition for dependency, and entered a
plea of: ..... Admit, ..... Deny, ..... Consent, ..... No Plea,
..... Continuance
..... The Petitioner:
….. will continue a diligent search and will attempt service.
..... has conducted an adequate diligent search and is excused
from further diligent search and further attempts at service.
3. The father, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a consent by default
..... did not enter a consent by default;
….. appeared with counsel….. appeared without counsel and:
….. was….. was not advised of his right to legal counsel;
….. knowingly, intelligently, and voluntarily, …..waived
……did not waive his right to legal counsel; and
……was ….. was not determined to qualify as indigent
and….. was ….. was not appointed an attorney......
was served with a petition for dependency, and entered a plea of:
..... Admit, ..... Deny, ..... Consent, ..... No Plea, ..... Continuance
..... The Petitioner:
..... will continue a diligent search and will attempt service.
..... has conducted an adequate diligent search and is excused
from further diligent search and further attempts at service.
4. That the child(ren)’s current placement in shelter care:
..... is no longer appropriate, and the child(ren) shall be
returned to ……….
..... is appropriate, in that the child(ren) is/are in a setting
which is as family-like as possible, consistent with the
child(ren)’s best interest and special needs; and, that returning
the child(ren) to the home would be contrary to the best interest
of the minor child(ren); and, that every reasonable effort has
been made to eliminate the need for placement of the child(ren)
in shelter care, but present circumstances of the child(ren) and
the family are such that shelter care is the only way to ensure
the child(ren)’s health, safety, and well-being.
5. Additional findings: ……….
THEREFORE, based on the foregoing findings of fact, it is
hereby ORDERED and ADJUDGED that:
1. The minor child(ren) shall:
..... be ..... returned to ..... remain in the care and custody of
.....(name)......
..... remain in the care and custody of the department in
shelter care pending adjudication and disposition or until further
order of this court.
2. The child(ren): ..... is/are ..... is/are not adjudicated
dependent at this hearing.
3. ..... Mediation ..... A case planning conference is/are
ordered at this time and shall be conducted on .....(date)......, at
.......... a.m./p.m., at .....(location)...... All parties, unless otherwise
specified, shall attend.
4. As to the mother, .....(name)....., the court:
Accepts the plea of: ..... Admit, ..... Deny, ..... Consent, .....
Continuance.
.....Appoints ..... Does not appoint an attorney.
Sets a hearing for ..... re-arraignment ...... adjudicatory trial
..... disposition and case plan hearing ..... trial status on
.....(date)..... at ..... a.m./p.m.
5. As to the father, .....(name)....., the court:
Accepts the plea of: ..... Admit, ..... Deny, ..... Consent, .....
Continuance.
..... Appoints ..... Does not appoint an attorney.
Sets a hearing for ..... re-arraignment ...... adjudicatory trial
..... disposition and case plan hearing ..... trial status on
.....(date)..... at ..... a.m./p.m.
6. All prior orders not inconsistent with the present order
shall remain in full force and effect.
DONE AND ORDERED on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)..... or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.966. ADJUDICATION ORDER — DEPENDENCY
ORDER OF ADJUDICATION
THIS CAUSE came before this court on .....(date)....., under
chapter 39, Florida Statutes, for adjudication of the Petition for
Dependency filed by .....(petitioner’s name)....... Present before the
court were:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name(s))....., Minor child(ren)
..... .....(Name)....., Attorney ad litem for minor child(ren)
..... .....(Name)....., 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.
The court having heard testimony and argument and being
otherwise fully advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings, is/are dependent within the meaning and
intent of chapter 39, Florida Statutes, and is/are (a) resident(s) of
the State of Florida.
2. The mother, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of her right to legal counsel,
..... knowingly, intelligently, and voluntarily ..... waived .....
did not waive her right to legal counsel and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
3. The father, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of her right to legal counsel,
..... knowingly, intelligently, and voluntarily ..... waived .....
did not waive her right to legal counsel and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
……4. That the child(ren) is/are dependent within the
meaning and intent of chapter 39, Florida Statutes, in that the
mother, ....(name)....., abused, neglected, or abandoned the minor
child(ren) by ................................. These facts were proven by .....
preponderance of the evidence ...... clear and convincing evidence.
……5. That the child(ren) is/are dependent within the
meaning and intent of chapter 39, Florida Statutes, in that the
father, .....(name)....., abused, neglected, or abandoned the minor
child(ren) by ............................... These facts were proven by .....
preponderance of the evidence ...... clear and convincing evidence.
COMMENT: Use 6, 7, and 8 only if the child is in out-of-home
placement.
6. That the Court finds that it is in the best interest of the
child(ren) to remain in out-of-home care.
7. That every reasonable effort was made to eliminate the
need for placement of the child(ren) in out-of-home care but the
present circumstances of the child(ren) and the ..... mother .....
father are such that out-of-home care is the only way to ensure the
health, safety, and well being of the child(ren), in that
..............................
8. That the child(ren)’s placement in .....(type of
placement)..... is in a setting which is as family like and as close to
the home as possible, consistent with the child(ren)’s best interests
and special needs.
9. That returning the minor child(ren) to the custody of
.....(person who had previous legal custody)..... would be contrary to
the best interest and welfare of the minor child(ren).
10. The Court informed any parents present that the parent
or parents shall provide the court and all parties with identification
and location information for such relatives.
THEREFORE, based upon the foregoing findings, it is
ORDERED AND ADJUDGED that:
1. The minor child(ren), ......(name(s))....., is/are adjudicated
dependent.
2. The child(ren) shall remain in the care and custody of
..... the department in shelter care
..... other .....(name).....
pending disposition.
3. The parents shall provide to the Court and all parties
identification and location information regarding potential relative
placements.
4. 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.
5. This court shall retain jurisdiction over this cause to
enter any such further orders that may be deemed necessary for the
best interest and welfare of the minor child(ren).
6. All prior orders not inconsistent with the present order
shall remain in full force and effect.
7. Disposition is scheduled for .....(date)....., at ......
a.m./p.m.
DONE AND ORDERED on .....date..... at .....(city)....., Florida.
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above styled cause on .....(date)..... at .....a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.967. ORDER OF DISPOSITION, ACCEPTANCE OF
CASE PLAN, AND NOTICE OF HEARING
ORDER OF DISPOSITION, ACCEPTANCE OF CASE PLAN,
AND NOTICE OF HEARING
THIS CAUSE came before this court on .....(date)....., under
chapter 39, Florida Statutes, for disposition of the Petition for
Dependency and acceptance of the Case Plan filed by the
Department of Children and Family Services.
The following persons appeared before the court:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other ..........
The court having considered the family functioning
assessment and Case Plan filed by the department and having
heard testimony and argument and being otherwise fully advised in
the premises finds that:
1. The minor child(ren) who is/are the subject matter of
these proceedings, was/were adjudicated dependent within the
meaning and intent of chapter 39, Florida Statutes, continue to be
dependent, and is/are residents of the State of Florida.
2. The minor child(ren) is/are of an age subject to the
jurisdiction of this Court.
3. The following parties were notified of this hearing and
provided a copy of the Case Plan and family functioning assessment
filed in this cause:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Other ..........
4. The mother, .....(name).....:
..... did not appear and ..... was .... was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of her right to legal counsel;
..... knowingly, intelligently, and voluntarily ..... waived
..... did not waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent
and ..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was .....was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of his right to legal counsel;
..... knowingly, intelligently, and voluntarily ..... waived
..... did not waive his right to legal counsel; and
..... was ..... was not determined to qualify as indigent
and ..... was ..... was not appointed an attorney.
6. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of persons notified)......
7. The department filed a family functioning assessment
with the court on .....(date)...... This family functioning assessment
..... is ..... is not in compliance with the statutory requirements.
8. The department filed a case plan with the court on
.....(date)......
a. The terms of the case plan ..... are ..... are not
consistent with the requirements of the law and previous orders of
this court.
b. The case plan ..... is ..... is not meaningful and
designed to address the facts and circumstances on which the court
based the finding of dependency.
c. The case plan ..... is ..... is not in the best interest of
the minor child(ren).
d. The case plan’s stated goal of .......... ..... is ..... is
not a reasonable goal.
e. The parents ..... have ..... do not have the ability to
comply with the terms of the case plan.
9. There is a need for temporary child support from
.....(noncustodial parent(s))..... and that he/she/they ..... has/have
..... do/does not have the ability to pay child support.
COMMENT: Use 10, 11 & 12 if child(ren) is/are not placed in the
home of a parent.
10. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)......
11. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
12. Return of the minor child(ren) to the custody of
.....(person from whom child(ren) was/were originally removed)....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely ..... remain ..... return home
with services and removal of the child(ren) is necessary to protect
the child(ren), in that ………..
13. Prevention or reunification services ..... were not ..... were
indicated and are as listed: ......(services indicated)...... Further
efforts could not have shortened separation of this family because:
………..
COMMENT: Use 14 if the goal of the case plan is reunification.
14. Reasonable efforts to prevent or eliminate the need for
removal of the child(ren) have been made by the department, which
provided the following services: ……….
COMMENT: Use 15 if child(ren) remain(s) or is/are returned to the
parent(s).
…..15. The child(ren) can safely ..... remain with ..... be
returned to ..... (parent(s)’s name(s))..... as long as he/she/they
comply(ies) with the following: ……….
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
……1. The minor child(ren), .....(name(s))..... be placed in
the custody of .....(name)....., under supervision of the department.
2. The family functioning assessment report filed by the
department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
..... accepted by the court with the following
amendments: ………..
3. The case plan filed by the department is:
..... not accepted and a continuance is granted for 30
days or less.
..... accepted by the court.
..... accepted by the court with the following
amendments: ……….
4. All parties are ordered to comply with the provisions of
the case plan and any amendments made to it.
COMMENT: Use 5, 6 & 7 if child(ren) is/are placed outside the
home.
…… 5. The mother, .....(name)....., shall pay child support
in the amount of $........... by the .....(day)..... of each month to
.....(where money is to be paid)....., beginning on .....(date)..... and
continuing until such time as payments begin to be deducted by
income deduction order. All child support payments shall be paid to
the Clerk of the Circuit Court designated to receive child support
payments.
…… 6. The father, .....(name)....., shall pay child support in
the amount of $........... by the .....(day)..... of each month to
.....(where money is to be paid)......, beginning on .....(date)..... and
continuing until such time as payments begin to be deducted by
income deduction order. All child support payments shall be paid to
the Clerk of the Circuit Court designated to receive child support
payments.
…… 7. The legal custodian shall have the right to authorize
for the child(ren) any emergency medical treatment and any
ordinary and necessary medical and dental examinations and
treatment, including blood testing, preventive care including
ordinary immunizations, tuberculin testing, and well-child care, but
not including nonemergency surgery, general anesthesia, provision
of psychotropic medications, or other extraordinary procedures for
which a separate order or informed consent as provided by law is
required.
8. Other: ………..
9. All prior orders not inconsistent with the present order
shall remain in full force and effect.
10. This court shall retain jurisdiction over this cause to
enter any such further orders that may be deemed necessary for the
best interest and welfare of the minor child(ren).
11. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in ...................., Florida, on
.....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at ..... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.968. AFFIDAVIT OF DILIGENT SEARCH
AFFIDAVIT OF DILIGENT SEARCH
STATE OF FLORIDA
COUNTY OF ..........
BEFORE ME, the undersigned authority, personally appeared
.....(name)....., affiant, who, being first duly sworn, deposes and says
that .....he/she..... made a diligent search and inquiry to determine
the residence of .....(name)....., the .....parent/prospective parent.....
of .....(name(s) of child(ren))....., and the results are as follows:
1. Affiant has received the name of the
.....(parent/prospective parent)..... from .....(name)......
2. Affiant has had no face-to-face contact with .....(name of
parent/prospective parent)......
3. On .....(date)..... affiant telephoned information at
.....(name)..... and was informed that there was no listing for
.....(name of parent/prospective parent)......
4. On .....(date)..... affiant searched the .....(city).....
telephone directory and was unable to locate a listing for .....(name
of parent/prospective parent)......
5. On .....(date)..... affiant sent a certified letter, return
receipt requested, to .....(address)....., a last known address of
.....(name of parent/prospective parent)...... On .....(date)..... affiant
received the unclaimed receipt by return mail.
6. On .....(date)..... affiant visited .....(address)....., the last
known address of .....(name of parent/prospective parent)....., and
was informed by .....(name)..... that .....(name of parent/prospective
parent)..... no longer resides there.
7. Affiant has made inquiries of all relatives of .....(name of
parent/prospective parent)..... of the child, including the other
parent, made known to me by the petitioner and .....(name)...... The
names, addresses, and telephone numbers of those relatives
contacted are: .......... None of the relatives contacted know the
current residence or whereabouts of .....(name of
parent/prospective parent)......
8. Affiant has made inquiries of all offices of program areas,
including but not limited to mental health, of the Department of
Children and Family Services likely to have information about
.....(name of parent/prospective parent)...... The names, addresses,
and/or telephone numbers of those offices are: .......... No one in
any of these offices knows the current residence or address of
.....(name of parent/prospective parent)......
9. Affiant has made inquiries of other state and federal
agencies likely to have information about .....(name of
parent/prospective parent)...... The names, addresses, and/or
telephone numbers of those agencies: ........... No one in any of these
agencies knows the current residence or whereabouts of .....(name
of parent/prospective parent)......
10. Affiant has made inquiries of appropriate utility and
postal providers. The names, addresses, and/or telephone numbers
of those providers are: ........... None of those providers know the
current residence or whereabouts of .....(name of
parent/prospective parent)......
11. Affiant has made inquiries of appropriate law
enforcement agencies. The names, addresses, and/or telephone
numbers of those agencies are: ........... .....(Name of
parent/prospective parent)..... is not known to any of these
agencies.
12. Affiant has made inquiries of the federal armed services,
including the United States Army, Navy, Air Force, Marine Corps,
and National Guard. .....(Name of parent/prospective parent)..... is
not currently a member of these services.
13. Affiant has made inquiries of all the hospitals in the
.......... area. The names, addresses, and/or telephone numbers of
those hospitals are: ........... .....(Name of parent/prospective
parent)..... is not currently a patient at, nor has .....he/she.....
recently been admitted to, these hospitals.
14. Affiant has conducted a thorough search of at least one
electronic database specifically designed for locating persons
including .....(name of database)...... No information regarding
.....(name of parent/prospective parent)..... was found in this
electronic database.
15. .....(Name of parent/prospective parent)..... .....is/is
not..... over 18 years of age.
16. Affiant is unable to determine the residence or
whereabouts of .....(name of parent/prospective parent)..... and thus
cannot personally serve process upon .....him/her......
Affiant
Before me, the undersigned authority, personally appeared
.....(name)....., the petitioner in this action, who .....is personally
known to me/produced .....(document)..... as identification....., and
who affirms that the allegations are filed in good faith and are true
and correct to the best of petitioner’s knowledge.
SWORN TO AND SUBSCRIBED before me .....(date)......
NOTARY PUBLIC
Name:……….
Commission No.:…………
My commission expires: …….
OR
Verification (see Form 8.902).
FORM 8.969. SWORN STATEMENT REGARDING IDENTITY OR
LOCATION OF FATHER
SWORN STATEMENT REGARDING
IDENTITY OR LOCATION OF FATHER
1. My name is: …………………………………………..
My address is: ………………………………………...
2. I am related to .....(child’s name)..... because I am his/her
....................
3. I understand that I am answering these questions under
oath and from my own personal knowledge and I swear to tell the
truth. I understand that this sworn statement will be filed with the
court.
4. The mother of the child WAS married to .....(name)..... at
the probable time of conception of the child.
OR
The mother of the child WAS NOT married at the probable
time of conception of the child.
OR
I do not know whether or not the mother was married at the
probable time of conception of the child.
5. The mother of this child WAS married to .....(name)..... at
the time of this child’s birth.
OR
The mother of this child WAS NOT married at the time of this
child’s birth.
OR
I do not know whether the mother of this child was married at
the time of this child’s birth.
6. The mother of this child WAS living with/cohabiting with
.....(name)..... at the time of the probable conception of this child.
OR
The mother of this child WAS NOT living with/cohabiting with
any man at the probable time of conception of this child.
OR
I do not know whether the mother of this child was living
with/cohabiting with any man at the probable time of conception of
this child.
7. The mother of this child HAS received payments or
promises of child support with respect to this child or because of
her pregnancy from .....(name)......
OR
The mother of this child HAS NOT received payments or
promises of child support with respect to this child or because of
her pregnancy from anyone.
OR
I do not know whether the mother has received any payments.
8. The mother named .................... as the father on the
child’s birth certificate.
OR
The mother DID NOT name a father on the child’s birth
certificate.
OR
I do not know whether the mother named a father on the
child’s birth certificate.
9. The mother named .................... as the father of this
child in connection with applying for public assistance.
OR
The mother HAS NOT named anyone as the father of this child
in connection with applying for public assistance.
OR
I do not know whether the mother has named anyone as the
father of this child in connection with applying for public assistance
benefits.
10. .....(Name)..... has been named in a paternity case or
acknowledged paternity in a jurisdiction where the mother lived at
the time of or since the conception of this child or where this child
resides or has resided.
OR
No man has been named in a paternity case or acknowledged
paternity of this child in a jurisdiction where the mother lived at the
time of or since the conception of this child or where this child
resides or has resided.
OR
I do not know if any man has been named in a paternity suit
regarding this child.
11. List the name, date of birth, social security number, and
last-known address of any man listed in this sworn statement:
Name: ……….
Date of birth: ……….
Social Security No.: ……….
Last-known address: ………..
12. Do you know any other information about the identity or
location of any man listed in this sworn statement? ..... Yes ..... No.
If so, please give that information:
I UNDERSTAND THAT THIS DOCUMENT WILL BE FILED WITH
THE COURT. UNDER PENALTY OF PERJURY, I DECLARE THAT
I HAVE READ IT AND THAT THE FACTS STATED ARE TRUE.
Date: ..........
Signature
Witnessed by .....(name)....., who is an authorized agent of the
Department of Children and Family Services and who attests that
the person who signed this statement provided proof of identify as
indicated:
..... Driver’s license, number:
………………………………...........…
..... Passport, number and country:
……………………………...........
..... Resident Alien (Green Card), number:
…………………..........…
..... Armed Forces Identification, number:
…………………..........….
..... Other: …………………………………………………….........…
FORM 8.970. ORDER ON JUDICIAL REVIEW
ORDER ON JUDICIAL REVIEW AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(name)....., Child
..... .....(name)....., Attorney for the child
..... .....(name)....., Petitioner
..... .....(name)....., Attorney for the petitioner
..... .....(name)....., Attorney for the department
..... .....(name)....., Department caseworker
..... .....(name)....., Mother
..... .....(name)....., Attorney for mother
..... .....(name)....., Father of .....(child).....
..... .....(name)....., Attorney for father
..... .....(name)....., Guardian ad litem
..... .....(name)....., Attorney for guardian ad litem
..... .....(name)....., Legal custodian
..... .....(name)....., Attorney for legal custodian
..... .....(name)....., 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 considered
..... Judicial Review and Social Study Report filed by the
department
..... Statement/home study filed by the department
..... Report of the guardian ad litem
..... Case plan filed by the department
..... Statement by the Child’s Caretaker
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child
..... Other ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings was/were adjudicated dependent, continue to
be dependent, is/are of an age subject to the jurisdiction of the
court, and is/are resident(s) of the state of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(name)....., Petitioner
..... .....(name)....., Attorney for the petitioner
..... .....(name)....., Attorney for the department
..... .....(name)....., Department caseworker
..... .....(name)....., Mother
..... .....(name)....., Attorney for mother
..... .....(name)....., Father of .....(child).....
..... .....(name)....., Attorney for father
..... .....(name)....., Guardian ad litem
..... .....(name)....., Attorney for guardian ad litem
..... .....(name)....., Legal custodian
..... .....(name)....., Attorney for legal custodian
..... .....(name)....., Attorney for the child
..... .....(name)....., Other ..........
3. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived
..... did not waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent
and
..... was ..... was not appointed an attorney.
4. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented
by legal counsel;
..... appeared ..... with ..... without legal counsel and .....
was ..... was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived .....
did not waive her right to legal counsel; and
..... was ..... was not determined to qualify as
indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
5. The department filed a judicial review report with the
court on .....(date)...... This judicial review report ..... is ..... is not in
compliance with the statutory requirements.
6. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
7. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
8. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
9. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
10. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
11. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
12. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
13. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
14. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
15. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
16. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
17. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
18. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 19, 20, 21, 22, 23, & 24 if child(ren) is/are not
placed in the home of a parent.
..... 19. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)......
..... 20. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
..... 21. The children ..... are ..... are not separated in their
placements. The following efforts have been made to reunite
separated siblings: ..........
..... It is not in the best interest of each sibling to be reunited in
their placement because: ..........
..... Each sibling has the following frequency, kind and duration of
contacts: ..........
..... 22. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally removed).....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely .....remain .....return home
with services and removal of the child(ren) is necessary to protect
the child(ren).
..... 23. Prevention or reunification services .....were not .....were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
..... 24. The likelihood of the children’s reunification with the
parent or legal custodian within 12 months is ...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
..... 25. The child(ren) can safely ..... remain with ..... be returned
to .....(parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ...........
The safety, well-being, and physical, mental, and emotional health
of the child(ren) are not endangered by allowing the child(ren) to .....
remain ..... return home.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the
custody of .....(name)....., under supervision of the department. The
department shall have placement and care responsibility while the
child(ren) is/are under protective supervision in an out-of-home
placement.
2. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
..... 3. The court finds that it is not likely that the
child(ren) will be reunified with the parent or legal custodian within
12 months after the child was removed from the home. The
department shall file a motion within 10 days of receipt of this
written order to amend the case plan to incorporate concurrent
planning into the case plan.
4. The court inquired of any parents present whether they
have relatives who might be considered for placement of the
children.
5. Other: ...........
6. All prior orders not inconsistent with the present order
shall remain in full force and effect.
7. This court shall retain jurisdiction over this cause to
enter any such further orders as may be deemed necessary for the
best interest and welfare of the minor child(ren).
8. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in .........., Florida on .....(date)..... at
.....(time).....
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.973A. ORDER ON JUDICIAL REVIEW FOR CHILD AGE
16
ORDER ON JUDICIAL REVIEW FOR CHILD
OVER AGE 16 AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department
that includes specific information related to the life skills that the
child has acquired since the child’s 13th birthday or since the date
the child came into foster care, whichever came later;
..... Statement/homestudy filed by the department;
..... Report of the guardian ad litem;
..... A case plan, dated .........., filed by the department;
..... Statement by the child’s caretaker on the progress the child
has made in acquiring independent living skills;
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings was/were adjudicated dependent, continue to
be dependent, is/are of an age subject to the jurisdiction of the
court, and is/are resident(s) of the state of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other: ..........
3. The child has been given the opportunity to address the
court with any information relevant to the child’s best interests.
4. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented by
legal counsel;
..... appeared ..... with ..... without legal counsel and ..... was
..... was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented by
legal counsel;
..... appeared ..... with ..... without legal counsel and ..... was
..... was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive his right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
6. The department filed a judicial review report with the
court on .....(date)...... This judicial review report ..... is ..... is not in
compliance with the statutory requirements.
7. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
8. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
9. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
10. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
11. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
12. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
13. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
14. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
15. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
16. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
17. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
18. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
19. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 20, 21, 22, 23, & 24 if child(ren) is/are not placed
in the home of a parent.
..... 20. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)...... The
department has placement and care responsibility while the
child(ren) is/are under protective supervision in an out-of-home
placement.
..... 21. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
..... 22. The children ..... are ..... are not separated in their
placements. The following efforts have been made to reunite the
siblings: ..........
..... It is not in the siblings’ best interest to be reunited in their
placement because: ..........
..... The separate siblings have the following frequency, kind,
and duration of contacts: ..........
..... 23. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally removed).....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely ..... remain ..... return home
with services and removal of the child(ren) is necessary to protect
the child(ren).
..... 24. Prevention or reunification services ..... were not ..... were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
..... 25. The child(ren) can safely ..... remain with ..... be returned
to .....(parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ........... The safety, well-being, and physical,
mental, and emotional health of the child(ren) are not endangered
by allowing the child(ren) to ..... remain ..... return home.
..... 26. The child’s petition and application for special immigrant
juvenile status or other immigration decision remains pending.
..... 27. The department ….. has ….. has not complied with its
obligation as specified in the written case plan or in the provision of
independent living services as required by Florida Statutes.
..... 28. The child has acquired the following life skills: ..........
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the custody
of .....(name)....., under supervision of the department.
2. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
3. Other: ...........
4. All prior orders not inconsistent with the present order shall
remain in full force and effect.
5. This court shall retain jurisdiction over this cause to enter any
such further orders as may be deemed necessary for the best
interest and welfare of the minor child(ren).
6. This court shall retain jurisdiction until the final decision is
rendered by the federal immigration authorities, or upon the
immigrant child’s 22nd birthday, whichever shall occur first.
7. This court shall retain jurisdiction until the child’s 19th
birthday for the purpose of determining whether appropriate
services to be provided to the young adult before reaching 18 years
of age have been provided to the youth.
8. This court shall retain jurisdiction until the child’s 21st
birthday, or 22nd birthday if the child has a disability, unless the
young adult chooses to leave foster care upon reaching 18 years of
age, or if the young adult does not meet the eligibility requirements
to remain in foster care or chooses to leave care at any time prior to
the 21st birthday, or 22nd birthday if the child has a disability.
9. This matter is scheduled for Judicial Review on .....(date)..... at
.....(time)......
DONE AND ORDERED in .........., Florida, on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to ...........
FORM 8.973B. ORDER ON JUDICIAL REVIEW FOR CHILD AGE
17 OR OLDER
ORDER ON JUDICIAL REVIEW FOR CHILD
OVER AGE 17 AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department;
..... Because the child reached the age of 17 within the past 90
days, written verification that the child:
..... Has been provided with a current Medicaid card
and has been provided all necessary information concerning the
Medicaid program;
..... Has been provided with a certified copy of his or her
birth certificate; and has a valid Florida driver’s license or has been
provided with a Florida identification card;
..... Has a social security card and has been provided
information relating to Social Security Insurance benefits, if the
child is believed to be eligible;
..... Has received a full accounting if there is a Master
Trust for the child and has been informed as to how to access those
funds;
..... Has been provided with information related to the
Road-to-Independence Program, including eligibility requirements,
information on participation, and assistance in gaining admission
to the program; If the child is eligible for the Road-to-Independence
Program, has been informed that he or she may reside with the
licensed foster family or group care provider with whom the child
was residing at the time of attaining his or her 18th birthday or
may reside in another licensed foster home or with a group care
provider arranged by the department;
..... Has an open bank account or the identification
necessary to open a bank account and the information necessary to
acquire essential banking and budgeting skills;
..... Has been provided with information on public
assistance and how to apply;
..... Has been provided a clear understanding of where
he or she will be living on his or her 18th birthday, how living
expenses will be paid, and what educational program the child will
be enrolled in;
..... Has been provided with information as to the child’s
ability to remain in care until he [or she] reaches 21 years of age or
22 years of age if he/she has a disability;
..... Has been provided with a letter stating the dates
that the child is under the jurisdiction of the court;
..... Has been provided with a letter stating that the
child is in compliance with financial aid documentation
requirements;
..... Has been provided his or her educational records;
..... Has been provided his or her entire health and
mental health records;
..... Has been provided with information concerning the
process for accessing his or her case file;
..... Has been provided with a statement encouraging
the child to attend all judicial review hearings occurring after his or
her 17th birthday; and
..... Has been provided with information on how to
obtain a driver license or learner’s driver license.
..... Statement/homestudy filed by the department;
..... Report of the guardian ad litem;
..... A case plan, dated .........., filed by the department;
..... Statement by the child’s caretaker on the progress the child
has made in acquiring independent living skills;
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings was/were adjudicated dependent, continue to
be dependent, is/are of an age subject to the jurisdiction of the
court, and is/are resident(s) of the state of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other: ..........
3. The child has been given the opportunity to address the
court with any information relevant to the child’s best interests.
4. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented by
legal counsel;
..... appeared ..... with ..... without legal counsel and ..... was
..... was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented by legal
counsel;
..... appeared ..... with ..... without legal counsel and ..... was .....
was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive his right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
6. The department filed a judicial review report with the
court on .....(date)...... This judicial review report ..... is ..... is not in
compliance with the statutory requirements.
7. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
8. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
9. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
10. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
11. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
12. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
13. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
14. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
15. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
16. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
17. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
18. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
19. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 20, 21, 22, 23, & 24 if child(ren) is/are not placed
in the home of a parent.
..... 20. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)......
The department has placement and care responsibility while
the child(ren) is/are under protective supervision in an out-of-
home placement.
..... 21. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family
like and as close to the home as possible, consistent with the
child(ren)’s best interests and special needs.
..... 22. The children ..... are ..... are not separated in their
placements. The following efforts have been made to reunite
the siblings: ..........
..... It is not in the siblings’ best interest to be reunited in their
placement because: ..........
..... The separate siblings have the following frequency, kind, and
duration of contacts: ..........
..... 23. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally
removed)..... would be contrary to the best interest and welfare of
the minor child(ren). The child(ren) cannot safely ..... remain .....
return home with services and removal of the child(ren) is necessary
to protect the child(ren).
..... 24. Prevention or reunification services ..... were not ..... were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
..... 25. The child(ren) can safely ..... remain with ..... be returned
to .....(parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ........... The safety, well-being, and physical,
mental, and emotional health of the child(ren) are not endangered
by allowing the child(ren) to ..... remain ..... return home.
..... 26. The child’s petition and application for special immigrant
juvenile status or other immigration decision remains pending.
..... 27. The department ….. has ….. has not complied with its
obligation as specified in the written case plan or in the provision of
independent living services as required by Florida Statutes.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the
custody of .....(name)....., under supervision of the department.
2. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
3. Other: ...........
4. All prior orders not inconsistent with the present order
shall remain in full force and effect.
5. This court shall retain jurisdiction over this cause to
enter any such further orders as may be deemed necessary for the
best interest and welfare of the minor child(ren).
6. This court shall retain jurisdiction until the final decision
is rendered by the federal immigration authorities, or upon the
immigrant child’s 22nd birthday, whichever shall occur first.
7. This court shall retain jurisdiction until the child’s 19th
birthday for the purpose of determining whether appropriate
services to be provided to the young adult before reaching 18 years
of age have been provided to the youth.
8. This court shall retain jurisdiction until the child’s 21st
birthday, or 22nd birthday if the child has a disability, unless the
young adult chooses to leave foster care upon reaching 18 years of
age, or if the young adult does not meet the eligibility requirements
to remain in foster care or chooses to leave care at any time prior to
the 21st birthday, or 22nd birthday if the child has a disability.
9. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in .........., Florida, on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to ...........
FORM 8.973C. ORDER ON JUDICIAL REVIEW
ORDER ON LAST JUDICIAL REVIEW BEFORE CHILD REACHES
AGE 18 AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department;
..... Statement/homestudy filed by the department;
..... Report of the guardian ad litem;
..... A case plan, dated .........., filed by the department that
includes information related to independent living services that
have been provided since the child’s 13th birthday or since the date
the child came into foster care, whichever came later;
..... Statement by the child’s caretaker on the progress the child
has made in acquiring independent living skills;
..... Whether or not the child is a citizen and, if the child is not a
citizen, the steps that have been taken to address the citizenship or
residency status of the child;
..... A copy of the child’s transition plan;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. That the minor child(ren) who …..is/are….. the subject
matter of these proceedings …..was/were….. adjudicated
dependent, continue to be dependent, is/are of an age subject to
the jurisdiction of the court, and …..is/are.....resident(s) of the state
of Florida.
2. The following parties were notified of this hearing and
provided a copy of the documents filed for this hearing:
..... .....(Name)....., Child
..... .....(Name)....., Attorney for the Child
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other: ..........
3. The child has been given the opportunity to address the
court with any information relevant to the child’s best interests.
4. The mother, .....(name).....:
..... did not appear and ..... was ..... was not represented by legal
counsel;
..... appeared ..... with ..... without legal counsel and ..... was .....
was not advised of her right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive her right to legal counsel; and
..... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
5. The father, .....(name).....:
..... did not appear and ..... was ..... was not represented by legal
counsel;
..... appeared ..... with ..... without legal counsel and ..... was .....
was not advised of his right to legal counsel;
knowingly, intelligently, and voluntarily ..... waived ..... did not
waive his right to legal counsel; and
.... was ..... was not determined to qualify as indigent and
..... was ..... was not appointed an attorney.
COMMENT: Repeat above for each father.
6. The department filed a judicial review report with the
court on .....(date)...... The judicial review report ..... is ..... is not in
compliance with the statutory requirements.
7. The following parents/legal custodians were notified of
their right to participate in the preparation of the case plan and to
receive assistance from any other person in the preparation of the
case plan: .....(names of those notified)......
8. The mother has complied with the following tasks in the
case plan: .....(list tasks complied with)......
9. The mother has not complied with the following tasks in
the case plan: .....(list tasks not complied with)......
10. The father, .....(father’s name)....., has complied with the
following tasks in the case plan: .....(list tasks complied with)......
11. The father, .....(father’s name)....., has not complied with
the following tasks in the case plan: .....(list tasks not complied
with)......
12. The mother ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
13. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered visitation as follows: .....(explanation of
visitation compliance)......
14. The department ..... has ..... has not complied with court
ordered visitation as follows: .....(explanation of visitation
compliance)......
15. The mother ..... has ..... has not complied with court
ordered financial support for the child as follows: .....(explanation of
financial compliance)......
16. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered financial support for the child as
follows: .....(explanation of financial compliance)......
17. The mother ..... has ..... has not complied with court
ordered meetings with the department as follows: .....(explanation of
meetings compliance)......
18. The father, .....(father’s name)....., ..... has ..... has not
complied with court ordered meetings with the department as
follows: .....(explanation of meetings compliance)......
19. The department ..... has ..... has not complied with court
ordered meetings with the parents as follows: .....(explanation of
meetings compliance)......
COMMENT: Use 20, 21, 22, 23, & 24 if child(ren) is/are not placed
in the home of a parent.
20. It is in the best interest of the minor child(ren) to be
placed in the care and custody of .....(placement ordered)...... The
department has placement and care responsibility while the
child(ren) is/are under protective supervision in an out-of-home
placement.
21. Placement of the minor child(ren) in the care and custody
of .....(placement ordered)..... is in a setting which is as family like
and as close to the home as possible, consistent with the
child(ren)'s best interests and special needs.
..... 22. The children ..... are ..... are not separated in
their placements. The following efforts have been made to reunite
separated siblings: ..........
..... It is not in the best interest of each sibling to be reunited in
their placement because: ..........
..... Each sibling has the following frequency, kind, and duration of
contacts: ..........
23. Return of the minor child(ren) to the custody of
.....(person(s) from whom child(ren) was/were originally removed).....
would be contrary to the best interest and welfare of the minor
child(ren). The child(ren) cannot safely ..... remain ..... return home
with services and removal of the child(ren) is necessary to protect
the child(ren).
24. Prevention or reunification services ..... were not ..... were
indicated and are as follows: .....(services indicated)...... Further
efforts could not have shortened separation of this family because
...........
COMMENT: Use 25 if child(ren) remain(s) or is/are returned to the
parent(s).
25. The child(ren) can safely ..... remain with ..... be returned to
..... (parent(’s)(s’) name(s))..... as long as he/she/they comply(ies)
with the following: ........... The safety, well-being, and physical,
mental, and emotional health of the child(ren) are not endangered
by allowing the child(ren) to ..... remain ..... return home.
26. The child’s petition and application for special immigrant
juvenile status or other immigration decision remains pending.
27. The department ..... has ..... has not complied with its
obligation as specified in the written case plan or in the provision of
independent living services as required by Florida Statutes.
..... 28. The child does plan on remaining in foster care.
a. the child will meet the requirements by ..........
b. the supervised living arrangement will be ..........
c. the child has been informed of
..... (1) the right to continued support and
services;
..... (2) the right to request termination of this
court’s jurisdiction and to be discharged from
foster care;
..... (3) the opportunity to reenter foster care
pursuant to Florida law; and
..... (4) the requirement to furnish
documentation of participation in a program
required for eligibility to remain in extended
foster care.
..... 29. The child does not plan on remaining in foster care.
The child has been informed of:
..... a. services of benefits for which the child may be
eligible based upon the child’s placement and length of time spent
in licensed foster care;
..... b. services or benefits that may be lost through a
termination of the court’s jurisdiction; and
..... c. other federal, state, local, or community-based
services or supports available to the child.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The minor child(ren), .....(name(s))....., be placed in the
custody of .....(name)....., under supervision of the department.
2. The judicial review report filed by the department is: .....
not accepted and a continuance was requested ..... accepted by the
court.
3. The child’s transition plan is: ..... not approved and a
continuance was requested ..... approved by the court.
4. Other: ..........
5. All prior orders not inconsistent with the present order
shall remain in full force and effect.
6. This court shall retain jurisdiction over this cause to
enter any such further orders as may be deemed necessary for the
best interest and welfare of the minor child(ren).
7. This court shall retain jurisdiction until the final decision
is rendered by the federal immigration authorities, or upon the
immigrant child’s 22nd birthday, whichever shall first occur.
8. This court shall retain jurisdiction until the child’s 19th
birthday for the purpose of determining whether appropriate
services that were required to be provided to the young adult before
reaching 18 years of age have been provided to the youth.
9. This court shall retain jurisdiction until the child’s 21st
birthday, or 22nd birthday if the child has a disability, unless the
young adult chooses to leave foster care upon reaching 18 years of
age, or if the young adult does not meet the eligibility requirements
to remain in foster care or chooses to leave care at any time prior to
the 21st birthday, or the 22nd birthday if the young adult has a
disability.
10. This matter is scheduled for Judicial Review on
.....(date)..... at .....(time)......
DONE AND ORDERED in .........., Florida, on .....(date)......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the above-
styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to: ..........
FORM 8.973D. ORDER ON JUDICIAL REVIEW FOR YOUNG
ADULTS IN EXTENDED FOSTER CARE
ORDER ON JUDICIAL REVIEW FOR YOUNG ADULTS IN
EXTENDED FOSTER CARE AND NOTICE OF NEXT HEARING
THIS CAUSE came on to be heard on .....(date)..... for Judicial
Review on the report filed by the Department of Children and
Families in this cause under chapter 39, Florida Statutes.
The following persons appeared before the court:
..... .....(Name)....., Young Adult
..... .....(Name)....., Attorney for the Young Adult
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for the guardian ad litem
..... .....(Name)....., 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.
and the court having considered:
..... Judicial Review Social Study Report filed by the department;
..... Case Plan filed by the department;
..... Report of the guardian ad litem;
..... A copy of the young adult’s transition plan;
..... A copy of the voluntary placement agreement;
..... Other: ..........
AND THE COURT having heard testimony and argument, and
having been otherwise duly advised in the premises finds:
1. The young adult ….. is ….. is not making progress in
meeting the case plan goals, as follows: ..........
2. The department ..... has or ..... has not made reasonable
efforts to finalize the permanency plan currently in effect.
3. The case plan and/or the young adult’s transition plan
shall be amended as follows: ..........
4. The Department and all services providers .....have …..
have not provided the appropriate services listed in the case plan.
….. The Department must take the following action to ensure the
young adult receives identified services that have not been provided:
..........
…… 5. The young adult ..... is ..... is not separated from siblings
in out-of-home care. The following efforts have been made to reunite
separated siblings: .....................................................
........................................................................................................
...................................................
........................................................................................................
...................................................
..... It is not in the best interest of each sibling to be reunited in
their placement because:
........................................................................................................
........................................................................................................
........................................................................................................
..... Each sibling has the following frequency, kind and duration of
contacts:
........................................................................................................
........................................................................................................
........................................................................................................
…… 6. The young adult has signed a voluntary placement
agreement for the sole purpose of ending the current removal
episode.
….. 7. Jurisdiction in this case should be terminated based on
the following facts:
..... a. The young adult has requested termination of
jurisdiction; or
..... b. The young adult has been informed by the
department of his or her right to attend this hearing and has
provided written consent to waive this right, and
..... c. The young adult has been informed of the potential
negative effects of early termination of care, the option to reenter
care before reaching 21 years of age, or 22 years of age if the young
adult has a disability, the procedure for and the limitations on
reentering care, and the availability of alternative services, and has
signed a document attesting that he or she has been so informed
and understands these provisions; or
..... d. The young adult has voluntarily left the program,
has not signed the document indicated above, and is unwilling to
participate in any further court proceeding; or
..... e. The young adult has been involuntarily discharged
from the program by written notification dated .........., and the
young adult has not appealed the discharge decision.
THEREFORE, based upon the foregoing findings, it is hereby
ORDERED AND ADJUDGED that:
1. The judicial review report filed by the department is:
..... not accepted and a continuance was requested.
..... accepted by the court.
2. All prior orders not inconsistent with the present order
shall remain in full force and effect.
3. The young adult is placed in the following supervised
living environment: .......... under the protective supervision of the
department. The department shall have placement and care
responsibility while the young adult is under protective supervision
in the supervised living environment. The court has determined that
it is in the best interest of the young adult to remain in out-of-home
care.
..... 4. The court ends the current removal episode. The
young adult executed a voluntary placement agreement on
.....(date)..... giving the department placement and care
responsibility and beginning a new removal episode.
..... 5. This court shall retain jurisdiction until the young
adult’s 19th birthday for the purpose of determining whether
appropriate services that were required to be provided to the young
adult before reaching 18 years of age have been provided to the
youth. or
..... 6. This court shall retain jurisdiction until the young
adult’s 21st birthday, or 22 years of age if the young adult has a
disability, unless the young adult chooses to leave foster care upon
reaching 18 years of age, or if the young adult does not meet the
eligibility requirements to remain in foster care or chooses to leave
care at any time prior to the 21st birthday. or
..... 7. Jurisdiction over this cause is hereby terminated.
..... 8. Other:…………………..
..... 9. This matter is scheduled for Judicial Review on
…..(date)….. at ……(time)…….
DONE AND ORDERED in …………………, Florida, on ……(date)…….
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above-styled cause on .....(date)..... at ..... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to: ……….
FORM 8.975. DEPENDENCY ORDER WITHHOLDING
ADJUDICATION
ORDER OF ADJUDICATION
THIS CAUSE came before this court on .....(date)....., under
chapter 39, Florida Statutes, for adjudication of the Petition for
Dependency filed by .....(petitioner’s name)...... Present before the
court were
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
The court having heard testimony and argument and being
otherwise fully advised in the premises finds:
1. That the minor child(ren) who is/are the subject matter
of these proceedings, is/are dependent within the meaning and
intent of chapter 39, Florida Statutes, and is/are (a) resident(s) of
the State of Florida.
2. The mother, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of her right to legal
counsel,
..... knowingly, intelligently, and voluntarily waived .....
did not waive her right to legal counsel and
..... was ..... was not determined to qualify as indigent
and
..... was ..... was not appointed an attorney.
3. The father, .....(name).....:
..... was ..... was not noticed of this hearing;
..... did not appear, and the court:
..... entered a Consent for failure to appear after proper
notice.
..... did not enter a Consent for failure to appear after
proper notice.
..... appeared with counsel;
..... appeared without counsel and:
..... was ..... was not advised of his right to legal
counsel,
..... knowingly, intelligently, and voluntarily waived
..... did not waive his right to legal counsel
and
..... was ..... was not determined to qualify as
indigent and
..... was ..... was not appointed an attorney.
..... 4. That the child(ren) is/are dependent within the meaning
and intent of chapter 39, Florida Statutes, in that the mother,
....(name)....., abused, neglected or abandoned the minor child(ren)
by .................... These facts were proven by ..... preponderance of
the evidence ...... clear and convincing evidence.
..... 5. That the child(ren) is/are dependent within the meaning
and intent of chapter 39, Florida Statutes, in that the father,
.....(name)....., abused, neglected or abandoned the minor child(ren)
by ..................... These facts were proven by ..... preponderance of
the evidence ...... clear and convincing evidence.
..... 6. That the parties have filed a mediation agreement in
which the parent(s) consent(s) to the adjudication of dependency of
the child(ren) in conjunction with a withhold of adjudication, which
the court accepts.
7. Under section 39.507(5), Florida Statutes, the Court
finds that the child(ren) named in the petition are dependent, but
finds that no action other than supervision in the child(ren)’s home
is required.
THEREFORE, based upon the foregoing findings, it is
ORDERED AND ADJUDGED that:
1. Under section 39.507(5), Florida Statutes, the Court
hereby withholds adjudication of dependency of the minor
child(ren). The child(ren) shall be .....returned/continued..... in
(child(ren)’s home) under the supervision of the department. If this
court later finds that the parents have not complied with the
conditions of supervision imposed, the court may, after a hearing to
establish the noncompliance, but without further evidence of the
state of dependency, enter an order of adjudication.
2. This court shall retain jurisdiction over this cause to
enter any such further orders that may be deemed necessary for the
best interest and welfare of the minor child(ren).
3. All prior orders not inconsistent with the present order
shall remain in full force and effect.
4. Disposition is scheduled for .....(date)....., at ......
a.m./p.m.
DONE AND ORDERED on .....date......
Circuit Judge
NOTICE OF HEARING
The Juvenile Court hereby gives notice of hearing in the
above styled cause on .....(date)..... at .......... a.m./p.m., before
.....(judge)....., at .....(location)....., or as soon thereafter as
counsel can be heard.
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, and 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.
PLEASE BE GOVERNED ACCORDINGLY.
Copies furnished to:
FORM 8.976. PROPOSED RELATIVE PLACEMENT
PROPOSED RELATIVES FOR PLACEMENT
Pursuant to Chapter 39, Florida Statutes, the
.....mother/father..... hereby provides the court and the parties with
the names and location of relatives who might be considered for
placement of the child(ren). The .....mother/father..... will continue
to inform the court and the parties of any relative who should be
considered for placement of the child(ren) with the filing of
subsequent forms.
MATERNAL
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
PATERNAL
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
Name: …………………………………
Address: ………………………………
Phone number: ………………….…….
Relationship to child: …………………
The above information is true and correct to the best of my
knowledge.
Dated ....................
(Mother’s Signature)
Printed name
……………….................
(Father’s Signature)
Printed name
……………….................
FORM 8.977. ORDER AUTHORIZING CHILD TO ENTER INTO
RESIDENTIAL LEASEHOLD AND SECURE
UTILITY SERVICES BEFORE THE CHILD’S 18TH
BIRTHDAY
ORDER AUTHORIZING CHILD TO ENTER INTO RESIDENTIAL
LEASEHOLD
AND TO SECURE RESIDENTIAL UTILITY SERVICES BEFORE THE
CHILD’S 18TH BIRTHDAY
THIS CAUSE came before the court to remove the disabilities
of nonage of .....(name)....., for the purpose of entering into a
residential leasehold and to secure residential utility services. The
court being fully advised in the premises FINDS as follows:
.....(Name)..... is 17 years of age, meets the requirements of
sections 743.045 and 743.046, Florida Statutes, and is entitled to
the benefits of those statutes.
THEREFORE, based on these findings of fact, it is ORDERED
AND ADJUDGED that the disabilities of nonage of .....(name)..... are
hereby removed for the purpose of entering a residential leasehold
and securing residential utility services. .....(Name)..... is hereby
authorized to make and execute contracts, releases, and all other
instruments necessary for the purpose of entering into a residential
leasehold and securing residential utility services. The contracts or
other instruments made by .....(name)..... for the purposes of
entering into a residential leasehold and securing residential utility
services shall have the same effect as though they were the
obligations of a person who is not a minor.
ORDERED at ..................................., Florida, on .....(date)......
Circuit Judge
Copies to:
FORM 8.978. ORDER AUTHORIZING CHILD TO SECURE
DEPOSITORY FINANCIAL SERVICES BEFORE
THE CHILD’S 18TH BIRTHDAY
ORDER AUTHORIZING CHILD TO SECURE
DEPOSITORY FINANCIAL SERVICES
BEFORE THE CHILD’S 18TH BIRTHDAY
THIS CAUSE came before the court to remove the disabilities
of nonage of .....(name)....., for the purpose of securing depository
financial services, and the court being fully advised in the premises
FINDS as follows:
.....(Name)..... is at least 16 years of age, meets the
requirements of section 743.044, Florida Statutes, and is entitled to
the benefits of that statute.
THEREFORE, based on these findings of fact, it is ORDERED
AND ADJUDGED that the disabilities of nonage of .....(name)..... are
hereby removed for the purpose of securing depository financial
services. .....(Name)..... is hereby authorized to make and execute
contracts, releases, and all other instruments necessary for the
purpose of securing depository financial services. The contracts or
other instruments made by .....(name)..... for the purpose of
securing depository financial services have the same effect as
though they were the obligations of a person who is not a minor.
ORDERED at ……….., Florida, on .....(date)......
Circuit Judge
Copies to:
FORM 8.978(a). ORDER CONCERNING YOUTH’S
ELIGIBILITY FOR FLORIDA’S TUITION AND FEE
EXEMPTION.
ORDER CONCERNING ELIGIBILITY FOR FLORIDA’S TUITION
AND FEE EXEMPTION
THIS CAUSE comes before the court to determine
.....(name).....’s eligibilty for the tuition and fee exemption under
Chapter 1009, Florida Statutes, and the court being fully advised in
the premises, it is
ORDERED AND ADJUDGED that .....(name)..... is eligible,
under Chapter 1009, Florida Statutes, and therefore exempt from
the payment of tuition and fees, including lab fees, at a school
district that provides postsecondary career programs, community
college, or state university.
ORDERED at………., Florida, on .....(date).....
Circuit Judge
Copies to:
D. TERMINATION OF PARENTAL RIGHTS FORMS
FORM 8.979. SUMMONS FOR ADVISORY HEARING
SUMMONS AND NOTICE OF ADVISORY
HEARING FOR TERMINATION OF
PARENTAL RIGHTS AND GUARDIANSHIP
STATE OF FLORIDA
TO: .....(name and address of person being summoned).....
A Petition for Termination of Parental Rights under oath has been
filed in this court regarding the above-referenced child(ren), a copy
of which is attached. You are to appear before .....(judge)....., at
.....(time and location of hearing)....., for a TERMINATION OF
PARENTAL RIGHTS ADVISORY HEARING. You must appear on the
date and at the time specified.
FAILURE TO APPEAR AT THIS ADVISORY HEARING
CONSTITUTES CONSENT TO THE TERMINATION OF PARENTAL
RIGHTS TO THIS CHILD (THESE CHILDREN). IF YOU FAIL TO
APPEAR ON THE DATE AND TIME SPECIFIED YOU MAY LOSE
ALL LEGAL RIGHTS TO THE CHILD (OR CHILDREN) NAMED IN
THE PETITION ATTACHED TO THIS NOTICE.
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 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.
Witness my hand and seal of this court at .....(city, county,
state)..... on .....(date)......
CLERK OF COURT
BY:
DEPUTY CLERK
CITATORIO Y AVISO DE
AUDIENCIA PARA LA TERMINACIÓN DE
PATRIA POTESTAD Y TUTELA
ESTADO DE FLORIDA
PARA: ..... (nombre y dirección de la persona citada).....
Se ha presentado una Petición de Terminación de la Patria Potestad
bajo juramento en este tribunal con respecto a los niños
mencionados anteriormente, cuya copia se adjunta. Usted debe
comparecer ante ..... (juez)....., en ..... (hora y lugar de la
audiencia)....., para una AUDIENCIA CONSULTIVA DE
TERMINACIÓN DE LA PATRIA POTESTAD. Deberá presentarse en
la fecha y hora que se especifiquen.
LA FALTA DE COMPARECENCIA EN ESTA AUDIENCIA
CONSULTIVA CONSTITUYE SU CONSENTIMIENTO PARA LA
TERMINACIÓN DE LA PATRIA POTESTAD DE ESTE NIÑO
(ESTOS NIÑOS). SI NO SE PRESENTA EN LA FECHA Y HORA
ESPECIFICADAS, PUEDE PERDER TODOS LOS DERECHOS
LEGALES SOBRE EL NIÑO (O NIÑOS) NOMBRADOS EN LA
PETICIÓN ADJUNTA A ESTE CITATORIO.
COMENTARIO: El siguiente párrafo debe estar en negrita, 14 pt.
fuente Times New Roman o Courier.
Si usted es una persona con una discapacidad que necesita
alguna adaptación para participar en este procedimiento, tiene
derecho, sin costo alguno para usted, a que se le provea de
cierta asistencia. Póngase en contacto con ..... (nombre,
dirección, número de teléfono)..... al menos 7 días antes de su
comparecencia programada ante el tribunal, o inmediatamente
después de recibir esta notificación si el tiempo antes de la
comparecencia programada es inferior a 7 días. Si tiene
problemas de audición o de voz, llame al 711.
Doy fe con mi firma y sello de este tribunal en ..... (ciudad,
condado, estado)..... en..... (fecha)......
SECRETARIO DEL TRIBUNAL
POR:
SECRETARIO ADJUNTO
MANDA AK AVÈTISMAN POU ENFOME-W
SOU YON CHITA TANDE, POU YO ANILE DWA-W
KÒM PARAN AK KÒM GADYEN
Leta Florid
POU: .....(non ak adrès moun yo voye manda-a).......
KÒM, tandiske, gen yon demann sèmante pou anile dwa paran-yo,
ki prezante devan tribinal-la, konsènan timoun ki nonmen nan lèt
sa-a, piwo-a, yon kopi dokiman-an kwoke nan dosye-a., yo bay lòd
pou prezante devan ..... (Jij-la) ...., a..... (nan.lè ak adrès chita
tande-a)......, NAN YON CHITA TANDE POU YO ENFÒME-W, YO
GEN LENTANSYON POU ANILE DWA-OU KÒM PARAN. Ou fèt pou
prezante nan dat ak lè ki endike-a.
SI OU PA PREZANTE NAN CHITA TANDE-A, POU YO ENFÒME-W,
YO GEN LENTANSYON POU ANILE DWA-OU KÒM PARAN, SA KA
LAKÒZ YO DESIDE OU KONSANTI TIMOUN SA-A (YO), BEZWEN
PWOTEKSYON LETA EPI SA KA LAKÒZ OU PÈDI DWA-OU KÒM
PARAN TIMOUN SA-A(YO), KI GEN NON YO MAKE NAN KOPI
DEMANN-NAN, KI KWOKE NAN AVÈTISMAN-AN
Si ou se yon moun infirm, ki beswen `ed ou ki bewsen ke o
akomode w pou ou patispe nan pwosedi sa yo, ou genyen dwa,
san ke ou pa peye, a setin `ed. Silvouple kontake …..(non,
address, telephone)….. o moin 7 jou avan dat ou genyen
rendevou pou ale nan tribunal, ou si le ou resevwa avi a, genyen
mouins ke 7 jou avan date endevou tribunal la. Ou si ou pa
tande pale, rele nan nimerro sa 711.
Mwen siyen non mwen e mete so mwen nan dokiman tribinal-
la kòm temwen nan (vil, distrik, eta) ....., nan ... (dat).......
GREFYE TRIBINAL-LA
PA:
ASISTAN GREFYE TRIBINAL-LA
FORM 8.980. PETITION FOR TERMINATION OF PARENTAL
RIGHTS BASED ON VOLUNTARY
RELINQUISHMENT
PETITION FOR TERMINATION OF
PARENTAL RIGHTS
Petitioner, .....(name)....., respectfully petitions this Court for
termination of parental rights and permanent commitment of the
minor child(ren), .....(name(s))....., to .....(agency name)..... for the
purpose of subsequent adoption, and as grounds states the
following:
A. PARTIES
1. The child, .....(name)....., is a male/female child born on
.....(date)....., at .....(city, county, state)...... At the time of the filing of
this petition, the child is .....(age)...... A copy of the child’s birth
certificate is attached to this Petition and incorporated as
Petitioner’s Exhibit ......
COMMENT: Repeat above for each child on petition.
2. The child(ren) is/are presently in the care and custody of
.....(name)....., and is/are residing in .................... County, Florida.
3. An affidavit under the Uniform Child Custody
Jurisdiction and Enforcement Act is attached to this as Petitioner’s
Exhibit .......
4. The natural mother of the child(ren) is .....(name)....., who
resides at ....................
5. The natural/alleged/putative father of the child(ren)
.....(name(s))..... is .....(name)....., who resides at ....................
COMMENT: Repeat #5 as necessary.
6. A guardian ad litem ..... has ..... has not been appointed
to represent the interests of the child(ren) in this cause.
B. GROUNDS FOR TERMINATION
1. The parent(s) have been advised of their right to legal
counsel at all hearings that they attended.
2. The parents will be informed of the availability of private
placement of the child with an adoption entity as defined in chapter
63, Florida Statutes.
3. The mother, .....(name)....., freely, knowingly, voluntarily,
and ..... with ..... without advice of legal counsel executed an
Affidavit and Acknowledgment of Surrender, Consent, and Waiver of
Notice on .....(date)....., for termination of her parental rights to the
minor child, .....(name)....., under section 39.806(1)(a), Florida
Statutes.
COMMENT: Repeat above as necessary.
4. The father, .....(name)....., freely, knowingly, and
voluntarily, and ..... with ..... without advice of legal counsel
executed an Affidavit and Acknowledgment of Surrender, Consent,
and Waiver of Notice on .....(date)....., for termination of his parental
rights to the minor child, .....(name)....., under section 39.806(1)(a),
Florida Statutes.
COMMENT: Repeat above as necessary.
5. Under the provisions of chapter 39, Florida Statutes, it is
in the manifest best interest of the child(ren) for parental rights to
be terminated for the following reasons:
..... allegations which correspond to sections 39.810(1)–
(11), Florida Statutes.
6. A copy of this petition shall be served on the natural
mother, .....(name).....; the father(s), .....(name(s)).....; the custodian,
.....(name).....; and the guardian ad litem, .....(name)......
7. This petition is filed in good faith and under oath.
WHEREFORE, the petitioner respectfully requests that this
court grant this petition; find that the parents have voluntarily
surrendered their parental rights to the minor child(ren); find that
termination of parental rights is in the manifest best interests of
this/these child(ren); and that this court enter an order
permanently committing this/these child(ren) to the .....(name).....
for subsequent adoption.
.....(petitioner’s name and
identifying information).....
Verification
.....(attorney’s name).....
.....(address and telephone
number).....
.....(email address(es).....
.....(Florida Bar number).....
Certificate of Service
FORM 8.981. PETITION FOR INVOLUNTARY TERMINATION OF
PARENTAL RIGHTS
PETITION FOR TERMINATION
OF PARENTAL RIGHTS
Petitioner, .....(petitioner’s name)....., respectfully petitions this
court for termination of parental rights and permanent commitment
of the minor child(ren), .....(name(s))....., to .....(agency name)..... for
the purpose of subsequent adoption, and as grounds states the
following:
A. PARTIES
1. The child, .....(name)....., is a male/female child born on
.....(date)....., at .....(city, county, state)...... At the time of the filing of
this petition, the child is .....(age)...... A copy of the child’s birth
certificate is attached to this Petition and incorporated as
Petitioner’s Exhibit ......
COMMENT: Repeat above for each child on petition.
2. The child(ren) is/are presently in the care and custody of
.....(name)....., and is/are residing in ………. County, Florida.
3. An affidavit under the Uniform Child Custody
Jurisdiction and Enforcement Act is attached to this as Petitioner’s
Exhibit ......
4. The natural mother of the child(ren) is .....(name)....., who
resides at …………
5. The natural/alleged/putative father of the child(ren)
.....(name(s))..... is .....(name)....., who resides at
……………………………………….
COMMENT: Repeat #5 as necessary.
6. A guardian ad litem ..... has ..... has not been appointed
to represent the interests of the child(ren) in this cause.
B. GROUNDS FOR TERMINATION
1. The parents have been advised of their right to legal
counsel at all hearings that they attended.
2. On or about .....(date(s))....., the following occurred:
.....(acts which were basis for dependency or TPR, if filed
directly)......
3. The mother has .....(grounds for TPR)..... the minor
child(ren) within the meaning and intent of section 39.806, Florida
Statutes, in that: .....(allegations which form the statutory basis for
grounds)......
4. The father has .....(grounds for TPR)..... the minor
child(ren) within the meaning and intent of section 39.806, Florida
Statutes, in that: .....(allegations which form the statutory basis for
grounds)......
5. Under the provisions of sections 39.810(1)–(11), Florida
Statutes, it is in the manifest best interests of the child(ren) for
parental rights of .....(name(s))..... to be terminated for the following
reasons: .....(allegations for each statutory factor in the manifest
best interest test)......
6. A copy of this petition shall be served on the natural
mother, .....(name)....., father(s), .....(name(s))....., the custodian,
.....(name).....; and the guardian ad litem, .....(name)......
7. This petition is filed by the petitioner in good faith and
under oath.
WHEREFORE, the petitioner respectfully requests that this
court grant this petition; find that the parents have abused,
neglected, or abandoned the minor child(ren); find that termination
of parental rights is in the manifest best interests of this/these
child(ren); and that this court enter an order permanently
committing this/these child(ren) to .....(agency)..... for subsequent
adoption.
.....(petitioner’s name and
identifying information).....
Verification
.....(attorney’s name).....
.....(address and telephone
number).....
.....(Florida Bar number).....
Certificate of Service
FORM 8.982 NOTICE OF ACTION FOR ADVISORY HEARING
.....(Child(ren)’s initials and date(s) of birth).....
NOTICE OF ACTION AND OF ADVISORY HEARING FOR
TERMINATION OF PARENTAL RIGHTS AND
GUARDIANSHIP
STATE OF FLORIDA
TO: .....(name and address of person being summoned)....
A Petition for Termination of Parental Rights under oath has
been filed in this court regarding the above-referenced child(ren).
You are to appear before .....(judge)....., at .....(time and address of
hearing)....., for a TERMINATION OF PARENTAL RIGHTS ADVISORY
HEARING. You must appear on the date and at the time specified.
FAILURE TO APPEAR AT THIS ADVISORY HEARING
CONSTITUTES CONSENT TO THE TERMINATION OF PARENTAL
RIGHTS TO THIS CHILD (THESE CHILDREN). IF YOU FAIL TO
APPEAR ON THE DATE AND TIME SPECIFIED YOU MAY LOSE
ALL LEGAL RIGHTS TO THE CHILD (OR CHILDREN) WHOSE
INITIALS APPEAR ABOVE.
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 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.
Witness my hand and seal of this court at .....(city, county,
state)..... on .....(date)......
CLERK OF COURT
BY:
DEPUTY CLERK
..... (Iniciales del niño (s) y fecha (s) de nacimiento).....
NOTIFICACIÓN DE AUDIENCIA CONSULTIVA PARA LA
TERMINACIÓN DE LA PATRIA POTESTAD Y
TUTELA
ESTADO DE FLORIDA
PARA: ..... (nombre y dirección de la persona citada)....
Se ha presentado una Petición de Terminación de la Patria
Potestad bajo juramento en este tribunal con respecto a los niños
mencionados anteriormente. Usted debe comparecer ante .....
(juez)....., en ..... (hora y dirección de la audiencia)....., para una
AUDIENCIA CONSULTIVA DE TERMINACIÓN DE LA PATRIA
POTESTAD. Deberá presentarse en la fecha y hora que se
especifiquen.
LA FALTA DE COMPARECENCIA EN ESTA AUDIENCIA
CONSULTIVA CONSTITUYE SU CONSENTIMIENTO PARA LA
TERMINACIÓN DE LA PATRIA POTESTAD DE ESTE NIÑO
(ESTOS NIÑOS). SI NO SE PRESENTA EN LA FECHA Y HORA
ESPECIFICADAS, PUEDE PERDER TODOS LOS DERECHOS
LEGALES SOBRE EL NIÑO (O NIÑOS) CUYAS INICIALES
APARECEN ARRIBA.
COMENTARIO: El siguiente párrafo debe estar en negrita, 14 pt.
fuente Times New Roman o Courier.
Si usted es una persona con una discapacidad que necesita
alguna adaptación para participar en este procedimiento, tiene
derecho, sin costo alguno para usted, a que se le provea de
cierta asistencia. Póngase en contacto con ...... (nombre,
dirección, número de teléfono)..... al menos 7 días antes de su
comparecencia programada ante el tribunal, o inmediatamente
después de recibir esta notificación si el tiempo antes de la
comparecencia programada es inferior a 7 días. Si tiene
problemas de audición o de voz, llame al 711.
Doy fe con mi firma y sello de este tribunal en ..... (ciudad,
condado, estado)..... en..... (fecha)......
SECRETARIO DEL TRIBUNAL
POR: ________________________
SECRETARIO ADJUNTO
MANDA AK AVÈTISMAN POU ENFOME-W
SOU YON CHITA TANDE, POU YO ANILE
DWA-W KÒM PARAN AK KÒM GADYEN.
LETA FLORID
POU: .....(non ak adrs moun yo voye manda-a).....
KÒM, tandiske, gen yon demann smante pou anile dwa paran-
yo, ki prezante devan tribinal-la, konsnan timoun ki nonmen nan lt
sa-a, piwo-a, yon kopi dokiman-an kwoke nan dosye-a., yo bay ld
pou prezante devan .....(Jij-la)....., a..... (nan.l ak adrs chita tande-
a)....., NAN YON CHITA TANDE POU YO ENOFME-W, YO GEN
LENTANSYON POU ANILE DWA-OU KÒM PARAN. Ou ft pou
prezante nan dat ak l ki endike-a.
SI OU PA PREZANTE NAN CHITA TANDE-A, POU YO
ENFOME-W, YO GEN LENTANSYON POU ANILE DWA-OU KÒM
PARAN, SA KA LAKÒZ YO DESIDE OU KONSANTI TIMOUN SA-A
(YO), BEZWEN PWOTEKSYON LETA EPI SA KA LAKÒZ OU PEDI
DWA-OU KÒM PARAN TIMOUN SA-A(YO), KI GEN NON YO MAKE
NAN KOPI DEMANN-NAN, KI KWOKE NAN AVÈTISMAN -AN
Si ou se yon moun infirm, ki beswen `ed ou ki bewsen ke o
akomode w pou ou patispe nan pwosedi sa yo, ou genyen dwa,
san ke ou pa peye, a setin `ed. Silvouple kontake …..(non,
address, telephone)….. o moin 7 jou avan dat ou genyen
rendevou pou ale nan tribunal, ou si le ou resevwa avi a, genyen
mouins ke 7 jou avan date endevou tribunal la. Ou si ou pa
tande pale, rele nan nimerro sa 711.
Mwen siyen non mwen e mete so mwen nan dokiman tribinal-
la km temwen nan .....(vil, distrik, eta)....., nan .....(dat)......
GREFYE TRIBINAL-LA
PA:
ASISTAN GREFYE TRIBINAL-LA
FORM 8.983. ORDER INVOLUNTARILY TERMINATING
PARENTAL RIGHTS
ORDER INVOLUNTARILY TERMINATING PARENTAL RIGHTS
THIS CAUSE came before this court on .....(all dates of the adjudicatory
hearing)..... for an adjudicatory hearing on the Petition for Termination of
Parental Rights filed by .....(name) ...... Present before the court were:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Child
..... .....(Name)....., Attorney for Child
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
The court has carefully considered and weighed the testimony of all
witnesses. The court has received and reviewed all exhibits.
COMMENT: Add the following only if necessary.
The petitioner has sought termination of the parental rights of .....(parent(s)) who is/are
subject of petition)......
The court finds that the parent(s), .....(name(s))....., has/have .....(list
grounds proved)....., under chapter 39, Florida Statutes. The grounds were
proved by clear and convincing evidence. Further, the court finds that
termination of parental rights of the parent(s), .....(name(s))....., is clearly in the
manifest best interests of the child(ren). The findings of fact and conclusions of
law supporting this decision are as follows:
1. At all stages of these proceedings the parent(s) was/were advised of
his/her/their right to legal counsel, or was/were in fact represented by
counsel.
2. On or about .....(date(s))....., the following occurred: .....(acts which
were basis for dependency or TPR, if filed directly)......
3. The mother has .....(grounds for TPR)..... the minor child(ren)
within the meaning and intent of section 39.806, Florida Statutes, in that:
.....(findings that form the statutory basis for grounds)......
4. The father has .....(grounds for TPR)..... the minor child(ren) within
the meaning and intent of section 39.806, Florida Statutes, in that:
.....(findings that form the statutory basis for grounds)......
5. The minor child(ren) to whom .....(parent’s(s’) name(s))..... parental
rights are being terminated are at substantial risk of significant harm.
Termination of parental rights is the least restrictive means to protect the
child(ren) from harm.
6. Under the provisions of sections 39.810(1)–(11), Florida Statutes, it
is in the manifest best interests of the child(ren) for parental rights of
.....(name(s))..... to be terminated for the reasons below. The court has
considered all relevant factors and finds as follows:
(a) Regarding any suitable permanent custody arrangement
with a relative of the child(ren), the court finds ...........
(b) Regarding the ability and disposition of the parent or parents
to provide the child(ren) with food, clothing, medical care, or other remedial
care recognized and permitted under state law instead of medical care, and
other material needs of the child(ren), the court finds ...........
(c) Regarding the capacity of the parent or parents to care for
the child(ren) to the extent that the child(ren)’s safety, well-being, and
physical, mental, and emotional health will not be endangered upon the
child(ren)’s return home, the court finds ...........
(d) Regarding the present mental and physical health needs of
the child(ren) and such future needs of the child(ren) to the extent that such
future needs can be ascertained based on the present condition of the
child(ren), the court finds ...........
(e) Regarding the love, affection, and other emotional ties
existing between the child(ren) and the child(ren)’s parent or parents,
siblings, and other relatives, and the degree of harm to the child(ren) that
would arise from the termination of parental rights and duties, the court finds
...........
(f) Regarding the likelihood of an older child remaining in long-
term foster care upon termination of parental rights, due to emotional or
behavioral problems or any special needs of the child(ren), the court finds
...........
(g) Regarding the child(ren)’s ability to form a significant
relationship with a parental substitute and the likelihood that the child(ren)
will enter into a more stable and permanent family relationship as a result of
permanent termination of parental rights and duties, the court finds ...........
(h) Regarding the length of time that the child(ren) has lived in
a stable, satisfactory environment and the desirability of maintaining
continuity, the court finds ...........
(i) Regarding the depth of the relationship existing between the
child(ren) and present custodian, the court finds ...........
(j) Regarding the reasonable preferences and wishes of the
child(ren), if the court deems the child(ren) to be of sufficient intelligence,
understanding, and experience to express a preference, the court finds ...........
(k) Regarding the recommendations for the child(ren) provided
by the child(ren)’s guardian ad litem or the legal representative, the court
finds ...........
(l) Regarding other relevant factors including .........., the court
finds ...........
COMMENT: Add items 7, 8, and 9 as applicable.
7. Under section 39.811(6)(..........), Florida Statutes, the court
terminates the parental rights of only .....(parent whose rights are being
terminated)..... as to the minor child(ren), .....(child(ren)’s name(s))......
Specifically, the court finds that .....(specific findings of fact under section
39.811(6), Florida Statutes)......
8. Under sections 39.509(5) and 39.811(7)(a), Florida Statutes, the
court finds that continued grandparental visitation is not in the best interests
of the child(ren) or that such visitation would interfere with the permanency
goals for the child(ren) for the following reasons ...........
9. Under section 39.811(7)(b), Florida Statutes, the court finds that
although parental rights are being terminated, the best interests of .....(names
of child(ren) to which this provision applies)..... support continued
communication or contact by .....(names of parents, siblings, or relatives of the
parent whose rights are terminated and to which this provision applies).....
except as provided above. The nature and frequency of the communication or
contact shall be as follows ........... It may be reviewed on motion of any party or
an identified prospective adoptive parent.
THEREFORE, after weighing the credibility of the witnesses, weighing all
statutory factors, and based on the findings of fact and conclusions of law
above, the court hereby ORDERS AND ADJUDGES THAT:
1. The petition filed by .....(name)..... is granted as to the parent(s),
.....(name(s))......
2. The parental rights of the father, .....(name)....., and of the mother,
.....(name)....., to the child, .....(name)....., are hereby terminated under section
39.806(..........), Florida Statutes.
COMMENT: Repeat the above for each child and parent, as necessary.
3. Under sections 39.811(2) and (5), Florida Statutes, the child(ren),
.....(name(s)) ....., are placed in the custody of .....(agency)..... for the purpose of
subsequent adoption.
4. The 30-day permanency plan required by section 39.811(8),
Florida Statutes, shall be filed and heard at .....(time)..... on .....(date)..... in
.....(location)......
DONE AND ORDERED on .....(date)....., in .....(city and county).....,
Florida.
Circuit Judge
NOTICE
Under section 39.815, Florida Statutes, any child, any parent,
guardian ad litem, or legal custodian of any child, any other
party to the proceeding who is affected by an order of the
court, or the department may appeal to the appropriate District
Court of Appeal within the time and in the manner prescribed
by the Florida Rules of Appellate Procedure, which is 30 days
from the date this order is rendered (signed and filed). A parent
may have the right to a court-appointed attorney as provided
by law.
Under Florida Rule of Juvenile Procedure 8.530, a parent, who
had an attorney in the termination of parental rights
proceeding, shall have 20 days after this order terminating
parental rights is entered to file a motion in the trial court
claiming ineffective assistance of counsel. A parent does not
have the right to a court-appointed attorney to assist the
parent with a motion claiming ineffective assistance of
counsel, but the parent may independently obtain an attorney
to represent the parent in the motion. The motion must
contain the case name, case number, and identify the date the
written order terminating parental rights was entered. The
motion must also contain the current mailing address and e-
mail address, if any, and the phone number(s) of the parent
filing the motion for the purpose of receiving notices and
orders. In the motion, the parent must identify specific acts or
omissions in the attorney’s representation of the parent during
the termination proceedings that the parent claims constituted
a failure to provide reasonable, professional assistance, and the
parent must explain how the errors or omissions prejudiced the
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated.
Copies to:
FORM 8.9831. MOTION CLAIMING INEFFECTIVE ASSISTANCE
OF COUNSEL AFTER ORDER TERMINATING
PARENTAL RIGHTS
MOTION CLAIMING INEFFECTIVE ASSISTANCE OF COUNSEL
AFTER ORDER TERMINATING PARENTAL RIGHTS
Moving parent, .....(name)....., .....(address)....., .....(e-mail
address)....., .....(phone number)....., requests this court to vacate
the order terminating parental rights pursuant to Florida Rule of
Juvenile Procedure 8.530.
1. I was the parent of .....(name(s) of child(ren))..... at the
time the court entered an order terminating my parental rights on
.....(date)..... in .....(case number and case name)......
2. My attorney failed to provide me with reasonable,
professional assistance by doing or not doing the following actions
during the termination of parental rights proceedings: (use
whatever space is necessary to explain your claims)
Comment: The phrase “termination of parental rights
proceedings” is not limited to the termination of parental rights
trial.
3. My attorney’s actions or inactions prejudiced my case to
such an extent that my parental rights would not have been
terminated because: (use whatever space is necessary to explain
your claims)
WHEREFORE, I request that the court enter an order granting
this motion, vacating the order terminating parental rights, and
providing any other relief the court deems proper.
I understand that I am swearing or affirming under oath to the
truthfulness of the claims made in this verified motion and that
punishment for knowingly making a false statement includes fines
and/or imprisonment.
(Your signature)
I certify that a copy of this document was .....(mailed, faxed
and mailed, hand delivered, or e-mailed)..... to the person(s) listed
below on .....(date)..... or was not delivered to the person(s) listed
below because ...........
List each party or the party’s attorney who you served:
Name: ..........
Address: ..........
Telephone Number: ..........
Fax Number: ..........
E-mail Address: ..........
(Your signature)
FORM 8.9832. ORDER ON MOTION CLAIMING INEFFECTIVE
ASSISTANCE OF COUNSEL AFTER ORDER
TERMINATING PARENTAL RIGHTS
ORDER ON MOTION CLAIMING INEFFECTIVE ASSISTANCE OF
COUNSEL AFTER ORDER TERMINATING PARENTAL RIGHTS
THIS CAUSE came before this court on .....(date)..... on the
Motion Claiming Ineffective Assistance of Counsel after Order
Terminating Parental Rights filed by .....(name)...... Present before
the court were:
..... .....(Name)....., Moving Parent
..... .....(Name)....., Attorney for Moving Parent
..... .....(Name)....., Trial Attorney for Moving Parent
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department caseworker
..... .....(Name)....., Child
..... .....(Name)....., Attorney for Child
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., Other ..........
Comment: Complete the following section if the court denies the
motion without a hearing.
The court has carefully considered the motion and reviewed all
necessary documents. The court finds that the motion should be
denied without a hearing because:
..... The motion is untimely.
1. The order terminating parental rights was entered on
.....(date)......
2. The moving parent filed the motion claiming ineffective
assistance of counsel on .....(date)......
3. Therefore, the moving parent filed the motion past the
20-day time limitation.
..... The motion is insufficient as alleged. The court finds that the
moving parent failed to allege specific facts that, if taken as
true, would support a finding that the attorney during the
termination of parental rights proceedings failed to provide
reasonable, professional assistance, and that any errors or
omissions prejudiced the parent’s case to such an extent that
but for counsel’s deficient performance the rights of the parent
would not have been terminated. Specifically the court finds:
.....(findings)......
Comment: Complete the following section if the court finds that the
motion is insufficient and directs the moving parent to file an
amended motion.
The court has carefully considered the motion and reviewed all
necessary documents.
..... The motion is insufficient as alleged. The court finds that the
moving parent failed to allege specific facts that would support
a finding that the attorney during the termination of parental
rights proceedings failed to provide reasonable, professional
assistance, and that any errors or omissions prejudiced the
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated. Specifically the court finds: .....(findings).....
However, the court finds that the moving parent should be
provided the opportunity to file an amended motion.
Comment: Complete the following section if the court previously
found that the motion was insufficient, directed the moving parent
to file an amended motion, and the parent failed to file an amended
motion within the time permitted.
The court previously carefully considered the motion and
reviewed all necessary documents.
..... On .....(date)....., the court found the motion is insufficient as
alleged. The court found that the moving parent failed to allege
specific facts that would support a finding that the attorney
during the termination of parental rights proceedings failed to
provide reasonable, professional assistance, and that any
errors or omissions prejudiced the parent’s case to such an
extent that but for counsel’s deficient performance the rights
of the parent would not have been terminated. Specifically the
court found: .....(findings)......
..... On .....(date)....., the court entered a written order providing
the parent an opportunity to file an amended motion. The
parent did not file an amended motion within 10 days of the
date of the written order permitting amendment.
Comment: Complete the following section if the court hearing was
conducted:
The court has carefully considered the motion, reviewed all
necessary documents, and having heard argument of counsel and
testimony, the court finds:
..... The motion is granted because the attorney during the
termination of parental rights proceedings failed to provide
reasonable, professional assistance, and the errors or
omissions prejudiced the parent’s case to such an extent that
but for counsel’s deficient performance the rights of the parent
would not have been terminated. Specifically the court finds:
.....(findings)......
..... The motion is denied because the attorney during the
termination of parental rights proceedings did not fail to
provide reasonable, professional assistance, or any errors or
omissions that were made did not prejudice the moving
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated. Specifically, the court finds: .....(findings)......
THEREFORE, the court hereby ORDERS AND ADJUDGES THAT:
..... The motion claiming ineffective assistance of counsel is denied
with prejudice.
..... The motion claiming ineffective assistance of counsel is
insufficient as alleged. The moving parent may file an
amended motion. Any amended motion shall be filed within 10
days of the date of this order or the court may summarily deny
the motion.
..... The motion claiming ineffective assistance of counsel is
granted. The order terminating parental rights entered on
.....(date)..... is hereby vacated and set aside as to .....(name of
moving parent)...... An adjudicatory hearing is hereby
scheduled for .....(date (no later than 45 days from this
order))....., and, as the court finds the parent is indigent,
.....(name of counsel)..... is hereby appointed to represent
.....(name of moving parent)..... in the termination of parental
rights proceedings.
DONE AND ORDERED on .....(date)....., in .....(city and
county)....., Florida.
Circuit Judge
Copies to:
FORM 8.984. ORDER TERMINATING PARENTAL RIGHTS
(VOLUNTARY)
ORDER TERMINATING PARENTAL RIGHTS (VOLUNTARY)
THIS CAUSE came before this court on .....(all dates of the
adjudicatory hearing)..... for an adjudicatory hearing on the petition
for termination of parental rights filed by .....(name)...... Present
before the court were:
..... .....(Name)....., Petitioner
..... .....(Name)....., Attorney for the petitioner
..... .....(Name)....., Attorney for the department
..... .....(Name)....., Department/agency caseworker
..... .....(Name)....., Child
..... .....(Name)....., Attorney/Attorney ad litem for Child
..... .....(Name)....., Mother
..... .....(Name)....., Attorney for mother
..... .....(Name)....., Father of .....(child).....
..... .....(Name)....., Attorney for father
..... .....(Name)....., Guardian ad litem
..... .....(Name)....., Attorney for guardian ad litem
..... .....(Name)....., Legal custodian
..... .....(Name)....., Attorney for legal custodian
..... .....(Name)....., 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.
..... The mother, .....(name)....., executed a voluntary
surrender of her parental rights for the minor child(ren),
.....(name(s))....., which is accepted by the court without objection.
COMMENT: Repeat the following as necessary.
..... The father, .....(name)....., executed a voluntary surrender
of his parental rights for the minor child(ren), .....(name(s)).....,
which is accepted by the court without objection.
The court has carefully considered the testimony of witnesses,
reviewed the exhibits, reviewed the file, heard argument of counsel,
and considered recommendations and arguments of all parties. The
court finds by clear and convincing evidence that the parents,
.....(names)....., have surrendered their parental rights to the minor
child(ren) under section 39.806(1)(a), Florida Statutes, and that
termination of parental rights is in the manifest best interests of the
child(ren). The specific facts and findings supporting this decision
are as follows:
1. That the mother, .....(name)....., ..... was ..... was not
personally served with the summons and the petition.
COMMENT: Service is not required if surrender was signed
before filing of petition.
2. That the father, .....(name)....., ..... was ..... was not
personally served with the summons and the petition.
COMMENT: Service is not required if surrender was signed
before filing of petition.
3. That the parents were advised of their right to counsel in
all prior dependency court proceedings which they attended. The
mother has been represented by legal counsel, .....(name).....,
starting on or about .....(date)..... The father has been represented
by legal counsel, .....(name)....., starting on or about .....(date)......
4. The mother, .....(name)....., freely, knowingly, voluntarily,
and ..... with ..... without advice of legal counsel executed an
affidavit and acknowledgment of surrender, consent, and waiver of
notice on .....(date)....., for termination of her parental rights to the
minor child(ren), under section 39.806(1)(a), Florida Statutes.
5. The father, .....(name)....., freely, knowingly, voluntarily,
and .....with ..... without advice of legal counsel executed an
affidavit and acknowledgment of surrender, consent, and waiver of
notice on .....(date)....., for termination of his parental rights to the
minor child(ren), under section 39.806(1)(a), Florida Statutes.
6. That at all times relevant to this action the interests of
this/these child(ren) has/have been represented by a guardian ad
litem. The guardian ad litem, .....(name)....., ..... agrees ..... does not
agree that it is in the best interests of the child(ren) for parental
rights to be terminated in this cause.
COMMENT: Guardian ad litem not required in voluntary
surrender.
7. Under the provisions of sections 39.810(1)–(11), Florida
Statutes, it is in the manifest best interests of the child(ren) for
parental rights to be terminated for the following reasons:
(a) Regarding any suitable permanency custody
arrangement with a relative of the child(ren), the court finds ...........
(b) Regarding the ability and disposition of the parent
or parents to provide the child(ren) with food, clothing, medical care
or other remedial care recognized and permitted under state law
instead of medical care, and other materials needs of the child(ren),
the court finds ...........
(c) Regarding the capacity of the parent or parents to
care for the child(ren) to the extent that the child(ren)’s safety, well-
being, and physical, mental, and emotional health will not be
endangered upon the child(ren)’s return home, the court finds
...........
(d) Regarding the present mental and physical health
needs of the child(ren) and such future needs of the child(ren) to the
extent that such future needs can be ascertained based on the
present condition of the child(ren), the court finds ...........
(e) Regarding the love, affection, and other emotional
ties existing between the child(ren) and the child(ren)’s parent or
parents, siblings, and other relatives, and the degree of harm to the
child(ren) that would arise from the termination of parental rights
and duties, the court finds ...........
(f) Regarding the likelihood of an older child remaining
in long-term foster care upon termination of parental rights, due to
emotional or behavioral problems or any special needs of the
child(ren), the court finds ...........
(g) Regarding the child(ren)’s ability to form a
significant relationship with a parental substitute and the likelihood
that the child(ren) will enter into a more stable and permanent
family relationship as a result of permanent termination of parental
rights and duties, the court finds ...........
(h) Regarding the length of time that the child(ren) has
lived in a stable, satisfactory environment and the desirability of
maintaining continuity, the court finds ...........
(i) Regarding the depth of the relationship existing
between the child(ren) and present custodian, the court finds
...........
(j) Regarding the reasonable preferences and wishes of
the child(ren), if the court deems the child(ren) to be of sufficient
intelligence, understanding, and experience to express a preference,
the court finds ...........
(k) Regarding the recommendations for the child(ren)
provided by the child(ren)’s guardian ad litem or the legal
representative, the court finds ...........
(l) Regarding other relevant factors including .........., the
court finds ...........
THEREFORE, it is ORDERED AND ADJUDGED that:
1. The petition for termination of parental rights is
GRANTED.
2. The parental rights of the father, .....(name)....., and of
the mother, .....(name)....., to the child(ren), .....(name(s))....., are
hereby terminated under section 39.806(..........), Florida Statutes.
COMMENT: Repeat the above for each child and parent on
petition.
3. The child(ren), .....(name(s))....., is/are hereby placed in
the permanent care and custody of .....(agency name)..... for
subsequent adoption.
4. A hearing for the department to provide a plan for
permanency for the child(ren) shall be held on .....(date)....., within
30 days of rendering of order, at .....(time)......
DONE AND ORDERED on .....(date)....., in .......... County,
Florida.
Circuit Judge
Copies to:
NOTICE
Under section 39.815, Florida Statutes, any child, any parent,
guardian ad litem, or legal custodian of any child, any other
party to the proceeding who is affected by an order of the
court, or the department may appeal to the appropriate District
Court of Appeal within the time and in the manner prescribed
by the Florida Rules of Appellate Procedure, which is 30 days
from the date this order is rendered (signed and filed). A parent
may have the right to a court-appointed attorney as provided
by law.
Under Florida Rule of Juvenile Procedure 8.530, a parent, who
had an attorney in the termination of parental rights
proceeding, shall have 20 days after this order terminating
parental rights is entered to file a motion in the trial court
claiming ineffective assistance of counsel. A parent does not
have the right to a court-appointed attorney to assist the
parent with a motion claiming ineffective assistance of
counsel, but the parent may independently obtain an attorney
to represent the parent in the motion. The motion must
contain the case name, case number, and identify the date the
written order terminating parental rights was entered. The
motion must also contain the current mailing address and e-
mail address, if any, and the phone number(s) of the parent
filing the motion for the purpose of receiving notices and
orders. In the motion, the parent must identify specific acts or
omissions in the attorney’s representation of the parent during
the termination proceedings that the parent claims constituted
a failure to provide reasonable, professional assistance, and the
parent must explain how the errors or omissions prejudiced the
parent’s case to such an extent that but for counsel’s deficient
performance the rights of the parent would not have been
terminated.
FORM 8.985. MOTION TO TERMINATE SUPERVISION AND
JURISDICTION
MOTION TO TERMINATE SUPERVISION
AND JURISDICTION
The Department of Children and Family Services, by and
through its undersigned counsel, moves this court for an order
terminating the department’s supervision and the court’s
jurisdiction and closing the file in the above-styled cause, and as
grounds states:
1. The parental rights previously were terminated and the
child(ren) was/were permanently committed to the care and
custody of the department for adoption by order of this court.
2. The adoption was finalized on .....(date)......
WHEREFORE, the Department of Children and Family
Services requests that this court terminate jurisdiction and the
department’s supervision and that the file be closed.
.....(attorney’s name).....
.....(address and telephone
number).....
.....(Florida Bar number).....
Certificate of Service
FORM 8.986. ORDER TERMINATING SUPERVISION AND
JURISDICTION
ORDER TERMINATING SUPERVISION AND JURISDICTION
THIS CAUSE having come before the court on motion to
terminate supervision and jurisdiction filed by the Department of
Children and Family Services, and the court being otherwise
advised in the premises, find the following:
1. The parental rights previously were terminated and the
child(ren) was/were permanently committed to the care and
custody of the department for subsequent adoption by order of this
court.
2. The adoption was finalized on .....(date)......
THEREFORE, based on these findings of fact, it is ORDERED
AND ADJUDGED:
That the supervision of the Department of Children and
Family Services and this court’s jurisdiction are terminated.
DONE AND ORDERED on .....(date)......
Circuit Judge
Copies furnished to:
E. JUDICIAL WAIVER OF PARENTAL NOTICE OF
TERMINATION OF PREGNANCY FORMS
FORM 8.987. PETITION FOR JUDICIAL WAIVER OF PARENTAL
NOTICE AND CONSENT OR CONSENT ONLY TO
TERMINATION OF PREGNANCY
IN THE CIRCUIT COURT OF THE ………. JUDICIAL CIRCUIT
IN AND FOR …………… COUNTY, FLORIDA
In the Interest of …………… (pseudonym or initials of minor)
Case No.: ……….
Division: ……….
PETITION FOR JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION OF PREGNANCY
I certify that the following information is true and correct:
(1) The pseudonym or initials of the minor (is/are)
.................................., and the minor has filed a Sworn Statement
of True Name and Pseudonym with the clerk.
(2) The minor is ..... years old.
(3) The minor is pregnant and parental notice or consent has not
been waived.
(4) The minor requests that the court enter an order authorizing
her to terminate her pregnancy without
[check which applies]
………. notice to and consent from her parents or legal guardian
………. consent only from her parents or legal guardian
for one or more of the following reasons:
[check all that apply]
..... a. The minor is sufficiently mature to decide whether
to terminate her pregnancy, for the following reason(s):
…………………………………………………................
........................................................................................................
....................................................
..... b. The minor is a victim of child abuse or sexual abuse
inflicted by one or both of her parents or a legal guardian.
..... c. Notice and consent or consent only from a parent or
legal guardian is not in the best interests of the minor, for the
following reason(s):
………………………………………………….............................................
........................................................................................................
.......................................................................................
(5) The minor requests the appointment of an attorney to
represent her in this matter; and the attorney is appointed at no
costs to the minor at least 24 hours prior to hearing.
[check one]
..... Yes, I want an attorney to represent me during the
judicial waiver proceedings at no cost to me.
..... No, I do not wish to be represented by an attorney.
(6) The minor elects the following method or methods for receiving
notices of hearings or other court actions in this case (you may
choose more than one option):
[check all that apply]
..... Through a third party whose name is .................... and whose
address and phone number for purposes of notice are ....................,
.....................
..... The minor will contact the office of the clerk of court at the
following phone number .......................................
I understand that by signing this form I am swearing to or
affirming the truthfulness of the claims made in this petition and
that the punishment for knowingly making a false statement
includes fines, imprisonment, or both.
Signature:
Date: ..........
(You may sign a name other than your true name, such as
Jane Doe or other pseudonym under which your petition is being
filed.)
FORM 8.988. SWORN STATEMENT OF TRUE NAME AND
PSEUDONYM
SWORN STATEMENT OF TRUE NAME AND PSEUDONYM
NOTICE TO THE CLERK OF COURT: A CERTIFIED COPY OF THIS
DECLARATION WITH THE CASE NUMBER NOTED ON IT SHALL
BE GIVEN TO THE MINOR AFTER SHE SIGNS IT.
THE ORIGINAL SHALL IMMEDIATELY BE PLACED IN A SEALED
ENVELOPE WHICH SHALL BE FILED UNDER SEAL AND KEPT
UNDER SEAL AT ALL TIMES.
(1) My true name is , and my address is
.
(print your name) (print your
address)
(2) My date of birth is .
(3) I have filed a Petition for Judicial Waiver of Parental Notice
and Consent or Consent Only to Termination of Pregnancy under
the name or initials on .
(date)
I understand that by signing this form I am swearing to or affirming
the truthfulness of the information herein and that the punishment
for knowingly making a false statement includes fines,
imprisonment or both.
Dated: Signature:
(You must sign your true name.)
FORM 8.989. ADVISORY NOTICE TO MINOR
ADVISORY NOTICE TO MINOR
[Case No.: ....................]
YOU ARE NOTIFIED as follows:
YOUR CASE NUMBER APPEARS AT THE TOP OF THIS FORM.
KEEP IT IN A SAFE PLACE. YOU CAN NOT GET INFORMATION
FROM THE CLERK WITHOUT YOUR CASE NUMBER.
YOU HAVE BEEN GIVEN A COPY OF THE SWORN STATEMENT
YOU SIGNED WITH YOUR TRUE NAME. KEEP IT IN A SAFE
PLACE. YOU MAY NEED TO SHOW IT AND THE FINAL JUDGMENT
IN YOUR CASE TO YOUR DOCTOR BEFORE TERMINATING YOUR
PREGNANCY.
All information in your case is confidential. No papers will be sent
to your home, and you will be contacted by this court only through
the method you elected in the petition. Your name will not be on
your court papers.
If you would like an attorney to help you with your case, the court
will appoint one for you at no cost to you. Your attorney will receive
notices about your case so he or she can prepare for and attend
hearings with you. You may also name someone else you trust to
receive notices for you. You can also contact the clerk of court
yourself to check on your case.
You have a right to a hearing and a decision on your case within 48
hours of filing your petition unless you or your attorney waives this
right or asks for an extension of time. If this time limit is not met
you have the right to ask the clerk for a form that will allow your
doctor to perform a termination of pregnancy without notifying a
parent.
If the court dismisses your petition, you have the right to appeal.
You will be given information regarding how to proceed with an
appeal, and if you would like an attorney to help you with an
appeal, you may request that the court appoint one.
I certify that I have given a copy of this advisory form to the minor.
Dated:……….
Clerk of Court
……….County Courthouse
……….,Florida
FORM 8.990. FINAL ORDER GRANTING PETITION FOR
JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION
OF PREGNANCY
FINAL ORDER GRANTING PETITION FOR JUDICIAL WAIVER OF
PARENTAL
NOTICE AND CONSENT OR CONSENT ONLY TO TERMINATION OF
PREGNANCY
THIS CAUSE having come before the court on a petition for
judicial waiver of parental notice and consent or consent only to
termination of pregnancy and the court being otherwise advised in
the premises, finds the following:
..... The minor has proven by clear and convincing evidence that
she is sufficiently mature to decide whether to terminate her
pregnancy, for the following reason(s): …………………………
……………………………..………………………………………………………
………………………………………………………………………………………
………………………………
The court has considered the following factors in reaching this
decision that the minor is sufficiently mature to decide whether to
terminate her pregnancy and makes the following findings:
The minor’s age is ……….
The minor’s overall intelligence indicates
…………………………………………………………………….
The minor’s emotional development and stability indicates
………………………………………………….
The minor’s credibility and demeanor as a witness indicates
…………………………………………………
The minor’s ability to accept responsibility is demonstrated by
……………………………………………..
The minor’s ability to assess both the immediate and long-
range consequences of the minor’s choices is demonstrated by
………………………………………………………………………………………
The minor’s ability to understand and explain the medical
risks of terminating her pregnancy and to apply that understanding
to her decision is indicated by
………………………………………………………………….……………………
………………………………………………………………………………………
Whether there may be any undue influence by another on the
minor’s decision to have an abortion.
………………………………………………………………………………………
………………………………………………………………………………………
..... The minor has proven by a preponderance of the
evidence that she is a victim of child abuse or sexual abuse inflicted
by one or both of her parents or a guardian, for the following
reason(s):
……………………………….………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
The court, having made a finding under this section, will
report the abuse as is required by section 39.201, Florida Statutes.
..... The minor has proven by clear and convincing evidence
that ………. notice and consent or ………. consent only from a
parent or legal guardian is not in the best interests of the minor, for
the following reason(s):
…………………………………………………….…………………………………
………………………………………………………………………………………
………………………………………………………………………………………
……………………………………………
THEREFORE, it is ORDERED AND ADJUDGED that:
1. The petition for judicial waiver of parental ………. Notice
and consent or………. Consent only to termination of pregnancy is
GRANTED.
2. ……The minor may consent to the performance or
inducement of a termination of pregnancy without notice to a
parent or legal guardian.
……The minor may consent to the performance or inducement
of a termination of pregnancy but notice to a parent or legal
guardian must be provided.
3. The clerk shall keep and maintain a confidential record of
these proceedings as provided by law, and shall seal the record.
DONE AND ORDERED in the .......... court in and for …………
County, Florida, on .....(date)......
Judge
FORM 8.991. FINAL ORDER DISMISSING PETITION FOR
JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION
OF PREGNANCY
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
In the interest of Case no.
(pseudonym or initials of minor) Division:
FINAL ORDER DISMISSING PETITION FOR
JUDICIAL WAIVER OF PARENTAL NOTICE AND CONSENT OR
CONSENT ONLY TO TERMINATION OF PREGNANCY
THIS CAUSE having come before the court on a petition for
judicial waiver of parental notice and consent or consent only to
termination of pregnancy and the court being otherwise advised in
the premises, finds the following:
….. It was not proven by clear and convincing evidence that the
minor is sufficiently mature to decide whether to terminate the
pregnancy; specifically, the court has considered the following
factors in reaching this decision and makes the following findings:
The minor’s age is: ……….
The minor’s overall intelligence indicates:
…………………………………………….…………………………………
………….
…………………………………………….…………………………………
…………..
The minor’s emotional development and stability indicate:
…………………………………………….…………………………………
…………..
…………………………………………….…………………………………
…………..
The minor’s credibility and demeanor as a witness indicates:
…………………………………………….…………………………………
…………..
…………………………………………….…………………………………
………….
The minor’s ability to accept responsibility is demonstrated by:
…………………………………………….…………………………………
…………..
…………………………………………….…………………………………
…………..
The minor’s ability to assess both the immediate and long-
range consequences of the minor’s choices is demonstrated by:
…………………………………………….…………………………………
…………
…………………………………………….…………………………………
…………
The minor’s ability to understand and explain the medical
risks of terminating her pregnancy and to apply that
understanding to her decision is indicated by:
………………………………………………………………….……………
………………………………………………………………………………
……………………………
The minor’s decision to have an abortion may have been made
under any undue influence by another is indicated by:
…………………………………………….…………………………………
……………
…………………………………………….…………………………………
………….....
….. It was not proven by the preponderance of the evidence that
the petitioner is the victim of child abuse inflicted by one or both of
her parents or her legal guardian;
….. It was not proven by clear and convincing evidence that ……….
notification of and consent from OR ………. consent only from the
parent or legal guardian is not in the best interests of the petitioner;
….. Other:
THEREFORE, it is ORDERED AND ADJUDGED that:
1. The petition for judicial waiver of parental notice and
consent or consent only to termination of pregnancy is DISMISSED.
2. The court shall provide a written transcript of all
testimony and proceedings as provided by law.
3. The clerk shall keep and maintain a confidential record of
these proceedings as provided by law, and shall seal the record.
4. THE MINOR HAS A RIGHT TO APPEAL THIS
DECISION. The clerk shall immediately provide Form 9.900(f)
Notice of Appeal of an Order Dismissing a Petition for Judicial
Waiver of Parental Notice and Consent or Consent Only to
Termination of Pregnancy and Advisory Notice to Minor to the minor
or petitioner if other than the minor.
DONE AND ORDERED in the ........ court in and for ............
County, Florida, on .....(date)......
_________________________
_____
Judge
FORM 8.992. MINOR’S PETITION TO CHIEF JUDGE TO
REQUIRE A HEARING ON HER PETITION FOR
JUDICIAL WAIVER OF NOTICE AND CONSENT
OR CONSENT ONLY
MINOR’S PETITION TO CHIEF JUDGE TO REQUIRE A HEARING
ON HER PETITION
FOR JUDICIAL WAIVER OF NOTICE AND CONSENT OR CONSENT
ONLY
I, …..(name)….., hereby petition the chief judge of this judicial
circuit for an order directing the judge to whom this case is
assigned to hold a hearing within 48 hours after receipt of this
petition by the chief judge, and requiring the court to enter an order
on my petition for judicial waiver of notice and consent or consent
only within 24 hours after the hearing.
In support of this petition, I say:
My petition for judicial waiver of notice and consent or consent
only was filed with the Clerk on …..(date)……
The third business day from the date of filing my petition was
…..(date)……
I have not requested an extension of time for the hearing
required to be conducted.
No hearing has been conducted by the court within the time
required by statute.
WHEREFORE, I ask the chief judge to enter an order requiring
the hearing on the petition for judicial waiver to be conducted
within the next 48 hours, and requiring the court to enter its order
within 24 hours after that hearing.
Signature:
_____________________
Date:
_________________________
Time:
________________________
[to be stamped by
Clerk]