Sheila
Moderator
Sample document from parent to Judge:
PLEASE COMPLETE AND RETURN THIS FORM TO THE JUVENILE PROBATION DEPARTMENT ON OR BEFORE __________, 200__.
CAUSE NO. ___________________
IN THE INTEREST OF: . IN THE ________________ COURT
.
. NO __________________________
.
________________________________ . _______________COUNTY, TEXAS
A JUVENILE . SITTING AS A JUVENILE COURT
PARENTAL WRITTEN STATEMENT
I, _________________________________________________
_______________________, a parent or other person responsible for the above named juvenile, submit this written statement as authorized under Texas Family Code Section 61.104. I would like to provide the following information so that the court can have my input for a better understanding of the needs and strengths of my child, our family and any other information important to the disposition of this case:
1. Background. The court should know the following information about my childâs background. (Use this space to describe information such as important events, drug problems or hardships that you believe have contributed to the circumstances your child is currently facing.)
_________________________________________________
_________________________________________________
________ _______________________________________
2. Medical and Psychological. The court should know the following medical and psychological history about my child. (Use this space to describe any medical conditions, illnesses, physical disabilities, medication needs, psychological history, psychological treatment or counseling, suicidal history, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
3. Education. The court should know the following information about my childâs school history. (Use this space to describe information such as any achievements or problems your child may have experienced in school including attendance, grades, special education, disciplinary problems, conflicts, extra-curricular activities, awards, sports, special skills and work, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
4. Home Environment. My childâs home environment and family situation can best be described as: (Use this space to tell the court about your childâs home life and environment such as information about how your child gets along with you, his or her brothers and sisters or any other person living at home, your childâs willingness to perform chores and other work around the house, behavior and discipline issues, whether your child has a job that adds to the household income, positive or negative neighborhood influences, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
5. Supervision. If the court places my child under my supervision, I plan to help my child stay out of trouble while on probation by: (Use this space to tell the court information such as your ability to supervise your child, any additional supportive adults who are available to assist you, problems you may have providing supervision, your plan to assist the probation department in making sure that your child will attend school and do everything the probation office requires, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
6. Childâs Positive Traits. The court should know the following good things about my child. (Use this space to tell the judge information such as any special achievements, character traits, volunteer work, past jobs, clubs, organizations, community or church activities in which your child participates.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
7. Recommended Outcome. When the court considers the final outcome of my childâs case, I recommend that the judge order the following: (Use this space to tell the judge what you think should happen to your child in this case. What you feel your childâs needs are. You may also want to discuss what will happen to your family if your child is removed from your custody and placed outside your home.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
8. Additional Information. The court should know the following important information that would be helpful to the court in making a final decision. (Use this space to provide the judge with any information that you feel may influence the judge when making a final decision.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
All the information I have provided to the court in this Parental Written Statement is true and correct to the best of my knowledge and belief.
___________________________________________ Date Signed: _________________________
Signature of Parent or Other Person
___________________________________________
Printed Name of Parent or Other Person
PLEASE COMPLETE AND RETURN THIS FORM TO THE JUVENILE PROBATION DEPARTMENT ON OR BEFORE __________, 200__.
CAUSE NO. ___________________
IN THE INTEREST OF: . IN THE ________________ COURT
.
. NO __________________________
.
________________________________ . _______________COUNTY, TEXAS
A JUVENILE . SITTING AS A JUVENILE COURT
PARENTAL WRITTEN STATEMENT
I, _________________________________________________
_______________________, a parent or other person responsible for the above named juvenile, submit this written statement as authorized under Texas Family Code Section 61.104. I would like to provide the following information so that the court can have my input for a better understanding of the needs and strengths of my child, our family and any other information important to the disposition of this case:
1. Background. The court should know the following information about my childâs background. (Use this space to describe information such as important events, drug problems or hardships that you believe have contributed to the circumstances your child is currently facing.)
_________________________________________________
_________________________________________________
________ _______________________________________
2. Medical and Psychological. The court should know the following medical and psychological history about my child. (Use this space to describe any medical conditions, illnesses, physical disabilities, medication needs, psychological history, psychological treatment or counseling, suicidal history, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
3. Education. The court should know the following information about my childâs school history. (Use this space to describe information such as any achievements or problems your child may have experienced in school including attendance, grades, special education, disciplinary problems, conflicts, extra-curricular activities, awards, sports, special skills and work, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
4. Home Environment. My childâs home environment and family situation can best be described as: (Use this space to tell the court about your childâs home life and environment such as information about how your child gets along with you, his or her brothers and sisters or any other person living at home, your childâs willingness to perform chores and other work around the house, behavior and discipline issues, whether your child has a job that adds to the household income, positive or negative neighborhood influences, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
5. Supervision. If the court places my child under my supervision, I plan to help my child stay out of trouble while on probation by: (Use this space to tell the court information such as your ability to supervise your child, any additional supportive adults who are available to assist you, problems you may have providing supervision, your plan to assist the probation department in making sure that your child will attend school and do everything the probation office requires, etc.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
6. Childâs Positive Traits. The court should know the following good things about my child. (Use this space to tell the judge information such as any special achievements, character traits, volunteer work, past jobs, clubs, organizations, community or church activities in which your child participates.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
7. Recommended Outcome. When the court considers the final outcome of my childâs case, I recommend that the judge order the following: (Use this space to tell the judge what you think should happen to your child in this case. What you feel your childâs needs are. You may also want to discuss what will happen to your family if your child is removed from your custody and placed outside your home.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
8. Additional Information. The court should know the following important information that would be helpful to the court in making a final decision. (Use this space to provide the judge with any information that you feel may influence the judge when making a final decision.)
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
All the information I have provided to the court in this Parental Written Statement is true and correct to the best of my knowledge and belief.
___________________________________________ Date Signed: _________________________
Signature of Parent or Other Person
___________________________________________
Printed Name of Parent or Other Person