I,                                                                              , parent, guardian, custodian of 

                                                                                     , have been informed of my right to a hearing pursuant  
to G.L. c. 119, § 24 or § 25 regarding temporary custody of my child(ren).    

 understand and acknowledge that by waiving this hearing I give up my right  
•  to be heard and object to the removal of my child(ren) from my custody;
•  to nominate a temporary custodian to provide care to my child(ren);  
•  to be heard as to whether or not the Department of Children and Families made reasonable 

efforts prior to removing my child(ren) from me to prevent or eliminate the need for his/her/their     
removal; and  

•  to appeal any determinations made and orders issued at this proceeding.   

 I

 
 
 
 

 

I hereby state that I waive my right to a temporary custody hearing.   

WAIVER OF TEMPORARY CUSTODY HEARING  
G.L. c. 119, § 24 or § 25

DOCKET NUMBER

Trial Court of Massachusetts 
Juvenile Court Department

CASE NAME

DIVISION

I am making this decision intelligently and voluntarily.  

Date:  

Signature: 

CERTIFICATE OF COUNSEL 

I, the undersigned counsel for the above named parent, guardian, custodian in the case captioned 
above, certify that I have discussed the waiver of the temporary custody hearing with my client.  I have 
explained that the waiver of the temporary custody hearing includes the right to be heard and object to 
the removal of the child(ren) from the home and to object to any custody orders regarding the child(ren) 
the judge may make at this hearing.  I have also explained that the waiver includes the right to nominate 
a temporary custodian and the right to be heard as to whether or not the Department of Children and 
Families made reasonable efforts prior to the removal of the child(ren) to prevent or eliminate the need 
for removal.  I have also explained that the waiver includes the right to appeal any determinations and 
orders the judge may make on these issues at this hearing.  

Date:  

Signature: 

JV-152 (11/05/2018)