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Temporary Physical Custody Request JD-1710 - Wisconsin
|Temporary Physical Custody Request Form. This is a Wisconsin form and can be used in Juvenile Circuit Court Statewide .||
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Referring Agency Case Number Intake Case Number Temporary Physical Custody Request Male Court Case Number Child's/Juvenile's/Expectant Mother's Name (Last, First, Middle) Date of Birth Female Asian or Pacific Islander African American America Indian or Alaskan Native Caucasian Hispanic Other Unknown Telephone Number County of Residence Child's/Juvenile's/Expectant Mother's Address Requesting Agency Complete Date and Time Taken Into Custody Why was person taken into custody? (§§48.19, 48.193 48.195 or 938.19) Taken Into Custody By Agency Warrant/capias Order by judge Criminal act Runaway Relinquishment Child/juvenile suffering from illness, injury or other danger Violation of terms of court-ordered supervision Violation of conditions of temporary custody order Violation of civil law or ordinance Unexcused absence from school Serious health risk to unborn child Work Telephone Number Statute and Descriptor: Legal Father's Name and Address Home Telephone Number Legal Mother's Name and Address Home Telephone Number Work Telephone Number Legal Guardian's Name and Address Home Telephone Number Work Telephone Number The parents notified by referring party? Yes (Date and Time) No Was notification under 48.193(2) given? Why was person not released? Yes No The parents notified by intake worker? Yes (Date and Time) No Was notification under 48.193(2) No Yes given? Were rights given? Yes No Jurisdictional Finding: (§48.205 and §938.205) 1. No jurisdiction. 2. Juvenile will commit injury to person or property of others. cause serious health risk to unborn child. be subject to injury by others. cause injury to self. 3. Person will: run away or be taken away so as to be unavailable for further court proceedings. unavailable unable refusing neglecting 4. Parent, guardian, legal custodian or other responsible adult is: to provide adequate supervision and care . Custody decision: 1. Person released. 2. Nonsecure custody: (§48.207 and §938.207) person not a relative. guardian. relative. parent. a. At the home of a b. At licensed foster home, treatment foster home, or group home. c. At non-secure facility operated by a licensed child welfare agency. d. At licensed private or public shelter care facility (including holdover room). §48.207(1m). e. For expectant mothers at 3. Secure custody because: (§48.208 and §938.208) runaway. physical harm to another. a. Juvenile has committed a delinquent act and there is a substantial risk of: runaway from a juvenile correctional facility. fugitive from another state. b. Juvenile is a : and there has been no reasonable opportunity to return the juvenile. c. A protective order has been issued and the child/juvenile consents in writing to the placement. d. Child/juvenile has run away or committed a delinquent act while in nonsecure placement. e. Juvenile is alleged/adjudicated delinquent and is a runaway from another county and would run away from nonsecure placement. f. Juvenile is subject to the jurisdiction of the adult criminal court and is under 15 years of age. 4. This is a secure custody placement in a jail because: (§48.209 and §938.209) a. No other approved juvenile detention facility is available. b. Child/juvenile is a substantial risk of physical harm to others in a juvenile detention facility. Name of Placement Address Telephone Number Intake Worker Complete Special precautions/information concerning child/juvenile/expectant mother Signature of Intake Worker Date and Time Custody Authorized Date and Time of Custody Hearing Date and Time of Release JD-1710, 10/07 Temporary Physical Custody Request Chapter 48 and 938, Wisconsin Statutes. American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material.