The parties stipulate and agree that the court may enter a consent decree, placing the child/juvenile under supervision, consistent with these terms and conditions

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY		For Official Use
IN THE INTEREST OF       Name	Consent Decree (Out of Home Placement Only)
      Date of Birth	Case No.      

The parties stipulate and agree that the court may enter a consent decree, placing the child/juvenile under supervision, consistent with these terms and conditions.

3. No referrals to intake and/or violations of federal, state, or local laws.

$       [Under age 14, $250 limit], payable to      

 Payment terms:      

 Make repairs or provide services agreeable to the victim. [Under age 14, 40 hour limit]  See attached

Amount:       hours. Terms:      

2. If restitution/repairs are ordered, the child/juvenile alone is financially able to pay or the custodial parent is financially able to pay.

3. If the child/juvenile is providing services for the victim, the child/juvenile is physically able to perform services for the victim [Under age 14, 40 hour limit] and the victim agrees to accept such services.
4. The consent decree is in the child’s/juvenile’s best interest and is approved.
5. The child’s/juvenile’s placement out-of-the home is maintained.

A. Placement in the home at this time  is  is not contrary to the child’s/juvenile’s welfare.

     

 made by the department or agency responsible for providing services.      

 made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child/juvenile from the home.      

 not required under §§48.355(2d) and 938.355(2d), Wis. Stats.      

 required, but the department or agency responsible for providing services failed to make reasonable efforts.

 made.

 not required because it would be contrary to the safety or well being of the child/juvenile or any of the siblings.

D. Permanency plan

 was not filed.

 was filed and reasonable efforts to achieve the permanency goal of the permanency plan, including through an out-of-state placement if appropriate, were

[Complete one of the following only if a permanency plan was filed]

 made by the department or agency responsible for providing services.      

 not made by the department or agency responsible for providing services.

6. As to the department or agency recommendation:

 A. The placement location recommended by the department or agency is adopted.

OR

 B. After giving bona fide consideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted.

and into the placement and care responsibility of the department in the county where this order is issued, or the

Divison of Milwaukee Child Protective Services if this order is issued in Milwaukee County under Ch. 48, which has primary responsibility for providing services.
 2. The child/juvenile has one or more siblings in out-of-home care and the child/juvenile is not placed with all those siblings. The department or agency

 shall make reasonable efforts to provide frequent visitation or other ongoing interaction between the child/juvenile and any siblings.

 is not required to provide for frequent visitation or other ongoing interaction because it would be contrary to the safety or well being of the child/juvenile or any siblings.
 3. The appointment of the guardian ad litem for the child/juvenile

 terminates until further order of the court.

 is continued to allow the guardian ad litem to perform any of the duties under §48.235(4) or §938.235(4), Wis. Stats.

 is continued for the following purpose(s):      

	mother		father		other:      	terminates until further order of the court.
	mother		father		other:      	is continued through the term of this order.
	mother		father		other:      	is continued for the following purpose(s):