Dependency Petition

DEPENDENCY PETITION In the Interest Of: ______________________, a Minor To the Honorable Judge of said Court: The petitioner respectfully represents that the above mentioned child is a DEPENDENT CHILD, as defined by The Juvenile Act at 42 Pa.C.S.§ 6302. It is within the jurisdiction of the Court and in the best interests of said child and the public that this proceeding be brought before the Court for the following reasons: The child: 1) is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his/her physical, mental, or emotional health, or morals; a determination that there is a lack of proper parental care or control may be based upon evidence of conduct by the parent, guardian or custodian that places the health, safety or welfare of the child at risk, including evidence of the parent's, guardian's or other custodian's use of alcohol or a controlled substance that places the health, safety or welfare of the child at risk; 2) has been placed for care or adoption in violation of law; 3) has been abandoned by his/her parents, guardian or other custodian; 4) is without a parent, guardian or other custodian; 5) while subject to compulsory school attendance is habitually and without justification truant from school; 6) has committed a specific act or acts of habitual disobedience of the reasonable and lawful commands of his/her parent, guardian, or other custodian and who is ungovernable and found to be in need of care, treatment or supervision; 7) is under the age of ten and has committed a delinquent act; 8) has been formerly adjudicated dependent, and who is under the jurisdiction of the court, subject to its conditions or placements and who commits an act which is defined as ungovernable; or 9) has been referred pursuant to an informal adjustment and who commits an act which is defined as ungovernable; 10) is born to a parent whose parental rights with regard to another child have been involuntarily terminated under 23 Pa.C.S. § 2511 (relating to grounds for involuntary termination) within three years immediately preceding the date of birth of the child and conduct of the parent poses a risk to the health, safety or welfare of the child. Specifically, on or about (date or time period): (State the facts supporting the allegations. Attach additional pages if necessary.) Additional pages attached. AOPC Form 9/29/2015 American LegalNet, Inc. www.FormsWorkFlow.com Dependency Petition, Page 1 of 4 DEPENDENCY PETITION Motion for Finding of Aggravated Circumstances Attached The petitioner alleges that the child is a victim of child abuse as defined at 23 Pa.C.S. §6303, in that: (Specify where the abuse occurred, nature and extent of the abuse, name and relationships of the persons responsible for causing the abuse and any evidence of prior abuse by those persons.) The petitioner avers that it would be contrary to the welfare, safety and health of the child to remain under the care of The petitioner avers that reasonable efforts were made to prevent the placement of the Child. The following efforts were made to prevent the placement of the child: Additional pages attached. The petitioner avers that preventive services were not offered due to the necessity for emergency placement. The lack of services was reasonable under the circumstances. This level of effort was reasonable due to the emergency nature of the situation, safety considerations, and circumstances of the family. The petitioner avers that there are no less restrictive alternatives available, because: The petitioner avers that the following family finding efforts were made: The petitioner avers that the following family members were contacted: The anticipated placement of the Child is: The Agency has determined it would pose a risk to the safety of the Child or guardian to release the current whereabouts of the Child. Wherefore, your petitioner prays this Honorable Court to fix a hearing to inquire into the matters alleged concerning the above named child and to make such order as deemed appropriate. If said child is found to be a dependent child and the Court determines that aggravated circumstances exist, your petitioner prays your Honorable Court to determine whether reasonable efforts to preserve and reunify the family shall be made or continue to be made and schedule any permanency hearing that may be required. Further, if the child is found to be dependent and is to enter placement or commitment, or otherwise be removed from the child's home at disposition, the petitioner seeks the Court to enter such order of disposition, to determine that to allow the child to remain in the home would be contrary to the welfare of the child; to determine whether reasonable efforts were made to prevent such removal of the child from the child's home; or if preventive services were not offered due to the emergency nature of the situation, safety considerations, and circumstances of the family, whether this level of effort was reasonable. American LegalNet, Inc. www.FormsWorkFlow.com AOPC Form Updated 9/29/2015 Dependency Petition, Page 2 of 4 DEPENDENCY PETITION If the Court determines, pursuant to 42 Pa.C.S. § 6332, that reasonable efforts were not made to prevent the initial removal of the child from the child's home, your petitioner prays your Honorable Court to determine, prior to entering an order of disposition under 42 Pa.C.S. § 6351, whether additional information is now available that would allow for a finding that such efforts were reasonable or whether reasonable efforts are underway to make it possible for the child to return home. The Petitioner verifies and acknowledges that the facts set forth in the petition are true and correct to the petitioner's personal knowledge, information, or belief, and that any false statements are subject to penalties of the Crimes Code, 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. PETITIONER NAME/TITLE ATTORNEY NAME PETITIONER SIGNATURE ATTORNEY SIGNATURE DATE DATE Adjudicatory Hearing Request: ________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com AOPC Form Updated 9/29/2015 Dependency Petition, Page 3 of 4 DEPENDENCY PETITION In the Interest Of: ______________________, a Minor ALLEGATIONS OF DEPENDENCY (Continuation of the facts supporting the allegations.) American LegalNet, Inc. www.FormsWorkFlow.com AOPC Form Updated 9/29/2015 Dependency Petition, Page 4 of 4