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

FOR COURT USE ONLY

JV-451

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:

CASE NAME:

PRISONER'S STATEMENT REGARDING APPEARANCE AT 
HEARING AFFECTING PARENTAL RIGHTS

CASE NUMBER:

I have read and understand, or I have had explained to me and I understand, the Order for Prisoner's Appearance at 
Hearing Affecting Parental Rights (form JV-450) that accompanies this form.

I understand that a hearing regarding my rights, responsibilities, and relationship to the following children (names):

1.  

2.  

will be held

on (date):

a.

b.

c.

a.

b.
c.

located at    

  

the court address above    

other (specify address):

at (time):

in Dept.:

Room:

Phone:

3.  

I understand that the hearing is set to

consider a petition to declare the child a dependent of the court under Welfare and Institutions Code section 300, 
which may limit my rights to the care, custody, and control of my child.

terminate my parental rights and select and implement a permanent plan of adoption for my child.

Other (specify code section and hearing purpose):

.

Right to attorney

4.  

I understand that I have a right to be represented by an attorney at the hearing. 

I already have a juvenile dependency attorney who will represent me at this hearing.

I want a juvenile dependency attorney appointed to represent me at this hearing.

I do not want to be represented, and I give up my right to be represented by an attorney at this hearing.

Form Adopted for Mandatory Use 
Judicial Council of California 
JV-451 [New January 1, 2012]

PRISONER'S STATEMENT REGARDING APPEARANCE 
AT HEARING AFFECTING PARENTAL RIGHTS

Page 1 of 3

Penal Code, § 2625
Cal. Rules of Court, rules 5.530(f), 5.531
www.courts.ca.gov

CASE NAME:

Right to be physically present

CASE NUMBER:

JV-451

You have the right to be physically present at the hearing described in items 2 and 3. If you give up the right to be physically 
present at that hearing, and either the court does not permit you to appear and participate by videoconference or telephone or 
the institution cannot accommodate your appearance and participation by videoconference or telephone, the court may 
proceed without you. 

5.  

I understand that I have a right to be physically present at the hearing described in items 2 and 3.

a.

b.

  I want to be physically present at that hearing.

I will need the assistance of an interpreter (specify language):

  I do not want to be physically present at the court and I give up that right. 

Request to appear by videoconference or telephone

If you have given up the right to be physically present at the hearing described in items 2 and 3, you may ask the court to let you  
appear and participate in the hearing by videoconference or telephone. 

6.  

I do not want to be physically present at the hearing described in items 2 and 3, and (check all that apply):

I understand that both the institution and the court have the equipment to allow me to appear and participate in the 
hearing by videoconference or telephone.

I understand that either the institution or the court does not have the equipment to allow me to appear and participate by 
videoconference or telephone. I understand that this means that I will not be able to appear and participate by 
telephone.

I want to participate in the hearing by videoconference or telephone. 

I will need the assistance of an interpreter (specify language):

I do not want to participate in the hearing by videoconference or telephone.

(TYPE OR PRINT NAME)

(SIGNATURE OF PARENT)

DECLARATION OF TRANSLATOR
(To be completed if prisoner does not understand English sufficiently to read this form.)

7.

a.  The prisoner’s primary language is   
b.  I certify that I translated Order for Prisoner's Appearance at  Hearing Affecting Parental Rights (JV-450) and this
     form for the prisoner in the prisoner’s primary language to the best of my ability.

  other (specify):

  Spanish   

a.

b.

c.

d.

Date:

Date:





(TYPE OR PRINT NAME)

(SIGNATURE OF INTERPRETER)

JV-451 (New January 1, 2012)

PRISONER'S STATEMENT REGARDING APPEARANCE
AT HEARING AFFECTING PARENTAL RIGHTS

Page 2 of 3

b.

c.

a.

b.

c.

Date:

CASE NUMBER:

JV-451

CASE NAME:

8.    

This institution

DECLARATION OF OFFICIAL 

a.    

can provide the prisoner with videoconference technology that complies with Cal. Rules of Court, rule 5.531.

can provide the prisoner with telephonic technology that complies with Cal. Rules of Court, rule 5.531.

cannot provide the prisoner with videoconference or telephonic technology that complies with Cal. Rules of Court, rule 
5.531.

To the official: Complete item 9 only if the prisoner has not completed items 1–6, above.

9.    

The prisoner (name): 

has expressly stated to me

has by the following conduct expressly indicated to me (describe conduct):

that he or she (check all that apply):

does not want to attend the hearing and waives the right to be physically present.

wants to appear and participate by videoconference or teleconference.

does not want to participate in the hearing in any way.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

(TYPE OR PRINT NAME)

(SIGNATURE)



(TITLE OF OFFICIAL)

IMPORTANT: PLEASE READ

A copy of this form must be provided by the clerk, social worker, or, if the court has not ordered the 
parent's appearance, parent's attorney of record to the parent and the warden or other person in charge 
of the institution where the parent is confined not less than 15 days before the scheduled hearing. This 
form must then be completed by the parent, interpreter, and person in charge of the institution, as 
appropriate, then filed with the court by the person in charge of the institution and returned to the 
parent's attorney of record not less than 8 court days before the scheduled hearing.

JV-451 (New January 1, 2012)

PRISONER'S STATEMENT REGARDING APPEARANCE
AT HEARING AFFECTING PARENTAL RIGHTS

Page 3 of 3