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Here is the text we could read:

The child,

is under the age of eighteen.

The child currently resides in

The child's parent(s) / guardian, 

(name of child)

(date and place of birth)

born on

(type of placement)

within the county of

(name of parent(s)/guardian with whom Voluntary Placement Agreement is made)

reside(s) at, 

(street address)

(city or town)

(zip)

The above named parent(s)/guardian, has/have entered into a Voluntary Placement Agreement with the Department of  
Children and Families, pursuant to which the child was placed in foster care on                                                                        

for reasons related to the child's

health

Other:

(date of placement)
and not to parental unfitness.

The Department and the parent(s)/guardian agree that continuation in placement is in the child's best interest and have 
agreed to extend the child's placement by amending the original Voluntary Placement Agreement.  The amended Voluntary 
Placement Agreement is attached hereto. 

he reason(s) for the child's need for continued placement is/are as follows:

 T

To the Justices of the Probate and Family Court: 
RESPECTFULLY represents the Department of Children and Families:

Division

Commonwealth of Massachusetts

The Trial Court
Probate and Family Court Department

Docket No.

PETITION FOR VOLUNTARY CARE AND RESPONSIBILITY OF

(name of child)

M.G.L. c. 119,    23(a)(1)

§

It is in the child's best interest to continue his/her placement with the Department because

WHEREFORE YOUR PETITIONER REQUESTS that this Honorable Court find that continued placement of the child named 
herein is in the child's best interest and enter a decree under the provisions of the General Laws of Massachusetts, Chapter 
119, s 23(a)(1), granting the Massachusetts Department of Children and Families care and responsibility of the child under 
the terms and conditions of the attached Voluntary Placement Agreement, or any extension thereof.  The Department of 
Children and Families further requests that this Honorable Court schedule a permanency hearing in accordance with the  
General Laws of Massachusetts, Chapter 119, s 23(a)(1).

Date

Date

CJ-P 97 (4/09)

(Signature of agency's representative)

(Print name)

(Street address)

(City/Town)

(State)

(Zip)

Tel. No.

B.B.O. #

I/We hereby consent to the continued placement of the child named in this petition and to the filing of this petition and having 
consented, I/We waive notice of the filing of this petition. 
 

(Signature of parent(s)/guardian)

Petition for Voluntary Care and Responsibility of a Child

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 1
Fields(s): 29
Average fields per page: 29
Reading Level: Grade 10
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

form_subform_divisions was form1[0].#subform[0].Divisions[0] (0.54 conf)
form_subform_text_field__1 was form1[0].#subform[0].TextField2[0] (0.37 conf)
form_subform_text_field__2 was form1[0].#subform[0].TextField2[1] (0.37 conf)
form_subform_text_field__3 was form1[0].#subform[0].TextField2[2] (0.37 conf)
form_subform_text_field__4 was form1[0].#subform[0].TextField2[3] (0.37 conf)
form_subform_text_field__5 was form1[0].#subform[0].TextField3[0] (0.37 conf)
form_subform_text_field__6 was form1[0].#subform[0].TextField2[4] (0.37 conf)
form_subform_text_field__7 was form1[0].#subform[0].TextField2[5] (0.37 conf)
form_subform_text_field__8 was form1[0].#subform[0].TextField3[1] (0.37 conf)
form_subform_text_field__9 was form1[0].#subform[0].TextField5[0] (0.37 conf)
form_subform_text_field__10 was form1[0].#subform[0].TextField2[6] (0.37 conf)
form_subform_check_box__1 was form1[0].#subform[0].CheckBox1[0] (0.42 conf)
form_subform_check_box__2 was form1[0].#subform[0].CheckBox1[1] (0.42 conf)
form_subform_text_field__11 was form1[0].#subform[0].TextField6[0] (0.37 conf)
form_subform_text_field__12 was form1[0].#subform[0].TextField7[0] (0.37 conf)
form_subform_text_field__13 was form1[0].#subform[0].TextField7[1] (0.37 conf)
form_subform_text_field__14 was form1[0].#subform[0].TextField7[2] (0.37 conf)
form_subform_text_field__15 was form1[0].#subform[0].TextField7[3] (0.37 conf)
form_subform_text_field__16 was form1[0].#subform[0].TextField7[4] (0.37 conf)
form_subform_text_field__17 was form1[0].#subform[0].TextField7[5] (0.37 conf)
form_subform_date_time_field__1 was form1[0].#subform[0].DateTimeField1[0] (0.35 conf)
form_subform_text_field__18 was form1[0].#subform[0].TextField5[1] (0.37 conf)
form_subform_text_field__19 was form1[0].#subform[0].TextField6[1] (0.37 conf)
form_subform_text_field__20 was form1[0].#subform[0].TextField7[6] (0.37 conf)
form_subform_text_field__21 was form1[0].#subform[0].TextField5[2] (0.37 conf)
form_subform_text_field__22 was form1[0].#subform[0].TextField5[3] (0.37 conf)
form_subform_text_field__23 was form1[0].#subform[0].TextField5[4] (0.37 conf)
form_subform_text_field__24 was form1[0].#subform[0].TextField5[5] (0.37 conf)
form_subform_date_time_field__2 was form1[0].#subform[0].DateTimeField1[1] (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition for Voluntary Care and Responsibility of a Child

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02