Application For Emergency Protective Custody

APPLICATION FOR EMERGENCY PROTECTIVE CUSTODY. This form is used in the Commonwealth of Pennsylvania by child welfare agencies or other authorized applicants to request immediate court intervention for the protection of a minor believed to be at risk. Filed with the Court of Common Pleas – Juvenile Division, this form is used when a child is alleged to be dependent under the Pennsylvania Juvenile Act (42 Pa.C.S. § 6302), due to abuse, neglect, abandonment, truancy, habitual disobedience, or other conditions that compromise the child's health, safety, or welfare. The application provides detailed information about the child, including name, age, sex, race, and residence, as well as details about the child’s parents, guardians, and any other known relatives or legal custodians. It also identifies whether the child is already in protective custody and includes the location of the child if known. The form outlines the specific legal grounds under which the court’s jurisdiction is invoked and includes a narrative section where the applicant explains the facts supporting the emergency custody request. It allows the applicant to indicate whether preventive services were offered or if immediate placement was necessary without such services. The application may also address special considerations, such as whether the child or others involved have been diagnosed with autism or whether the child may be recognized as an Indian child under federal or state law. Upon completion, the applicant affirms under penalty of perjury that the information is accurate. www.FormsWorkflow.com