ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

JV-190

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

                 TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD'S NAME:

WAIVER OF RIGHTS—JUVENILE DEPENDENCY

HEARING DATE AND TIME:

CASE NUMBER:

TO THE PARENT OF THE ABOVE NAMED CHILD:
Read this form carefully. The judge will ask you if you understand each right, and if you are voluntarily giving up that right.

For items 1, 2, and 3, check each box that applies, unless you have a question.

1.  Petition
a.  
b.

I have read the petition and I understand it.
The petition has been read to me and I understand it.

2.  Right to an Attorney.  You  have  the right  to  be  represented  by  an  attorney and one will be appointed for you if you cannot
     afford one, subject to a claim for payment.

I give up my right to be represented by an attorney. 
I request the court to appoint an attorney for me.

3.  Admission/Submission.  I wish to

a.
b.

a.

b.

c.

admit the allegations of the petition.
submit the petition on the basis of the social worker's or probation officer's report and other documents, if any. 
plead no contest.

For items 4 and 5, initial each box that applies, unless you have a question.

4.  Waiver of Rights.  By admitting the allegations of the petition, submitting the petition on the report, or pleading no
     contest, I am giving up the following rights:

Initial

a.  The right to a trial or hearing.
b.  The right to see and hear witnesses who testify.
c.  The right to cross-examine witnesses, the social worker or probation officer who prepared the report, and the persons
     whose statements are contained in the report.
d.  The right to testify in my own behalf and to present my own evidence and witnesses.
e.  The right to use the authority of the court to compel witnesses to come to court and to produce evidence.
f.   Any privilege against self-incrimination in this proceeding.

5.  Consequences

true.

a.  I understand that if I plead no contest or submit the petition on the report, the court will probably find that the petition is

b.  I understand that if the petition is found to be true and the child is declared a dependent of the court, the court may
assume custody of the child, and under certain circumstances, it is possible that no reunification services will  be 
offered or provided.

c.  (Child under age 3 years at time of initial removal) For a child under age 3 years at the time of initial removal, I understand 
     that if the court assumes custody of the child and I fail to participate regularly in court-ordered treatment, at the review in six 
     months services  may be terminated, and the court may make a permanent plan for the child, which could result in 
     termination of parental rights and placement of the child for adoption. 

Form Adopted for Mandatory Use
 Judicial Council of California
JV-190 [Rev. January 1, 2007]

WAIVER OF RIGHTS—JUVENILE DEPENDENCY

Page 1 of 2

Cal. Rules of Court, rule 5.504
 www.courtinfo.ca.gov

CHILD'S NAME:

CASE NUMBER:

JV-190

5.
     d.  (Child age 3 years or older at time of initial removal) For a child age 3 years or older at the time of initial removal, I understand 
that if the court assumes custody of the child and the child is not returned within one year, or at the most 18 months from 
the time the child was taken into physical custody, the court will make a permanent plan for the child, which could result 
in termination of parental rights and placement of the child for adoption.

Date:

Date:

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PARENT OR GUARDIAN)

DECLARATION OF INTERPRETER

6.  The primary language of the   

  parent    

  legal guardian is

  Spanish.
  other (specify):

I certify that I interpreted this form for the parent or legal guardian in that person's primary language to the best of my ability.

(TYPE OR PRINT NAME)

(SIGNATURE OF INTERPRETER)

7.  I am the attorney for the   

  parent   

  legal guardian.

I have explained and discussed with my client the rights and consequences of

DECLARATION OF ATTORNEY

  admitting the petition.
  pleading no contest.
  submitting the petition on the report.

(cid:96)

(cid:96)

(cid:96)

(TYPE OR PRINT NAME)

(SIGNATURE OF ATTORNEY)

JV-190 [Rev. January 1, 2007]

WAIVER OF RIGHTS—JUVENILE DEPENDENCY

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