
Declaration of Interpreter
WAIVER OF REUNIFICATION SERVICES
(Juvenile Dependency)
(SIGNATURE OF INTERPRETER)
(SIGNATURE OF PARENT OR GUARDIAN)
Declaration of Attorney (Required)
1.
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4.
a.
b.
WAIVER OF REUNIFICATION SERVICES
(Juvenile Dependency)
Form Adopted by the
Judicial Council of California
JV-195 [New July 1, 1998]
Welfare & Institutions Code, § 361.5
To parent or guardian of child: Read this form carefully. The judge will ask you if you understand your rights and are voluntarily
giving up those rights.
I am the
mother legally presumed father of the child, and I understand that if my child is removed from my
custody that I have a right to receive services to help me reunify with my child.
I am an alleged biological father of the child, and I understand that if I have been or am judged to be the biological father of the
child, the court may order service to help me obtain custody of the child.
The types of services that may be available have been explained to me.
I do not wish to receive services of any kind.
I do not wish to reunify with the child or have the child placed in my custody.
I understand that if no services are ordered, the court may
order services to the other parent.
set the matter for a hearing to decide on the best permanent plan for the child.
I understand that if I sign this form and the court is satisfied that I understand my rights and the consequences of
giving them up, at the hearing to select a permanent plan for the child, the court may terminate parental rights and
have the child placed for adoption.
5.
6.
7.
8.
9. I have discussed my rights with my attorney, and I knowingly and intelligently waive these services.
The parent or guardian is unable to read or understand this form of waiver because his or her primary language is
Spanish other (specify):
Date:
(TYPE OR PRINT NAME)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date:
(TYPE OR PRINT NAME)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.
I am the attorney for the parent or guardian. I have explained to the parent or guardian the nature of reunification services, including
the statutory time limits for such services. I have advised the parent or guardian of the parent's or guardian's right to such services
and the potential consequences of waiving them, including the likelihood that parental rights will be terminated and the child placed
for adoption. I am satisfied that the parent or guardian understands these rights and is voluntarily waiving them.
12.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FOR COURT USE ONLY
ATTORNEY FOR (Name):
CHILD'S NAME:
CASE NUMBER:
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):
FAX NO.:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CITY AND ZIP CODE:
BRANCH NAME:
STREET ADDRESS:
MAILING ADDRESS:
For items 4 through 9, initial each box that applies unless you have a question.
3.
I am the legal guardian.
I declare under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated this
form of waiver to the parent or guardian. The parent or guardian said he or she understood the form before signing it.
11.
Laura Lynn Morgan 31/03
Morgan I Love You