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NOTICE OF RIGHTS AND RESPONSIBILITIES 
WHEN APPEALING A JUVENILE COURT ORDER IN A CHILD WELFARE CASE
(Utah Code Ann. § 78A-6-359) 
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Case No(s).________________

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State in the interest of __________________
____________________________________,  

a child (or children) under the age 
of eighteen years. 

IN THE ________ DISTRICT JUVENILE COURT
IN AND FOR _____________ COUNTY, STATE OF UTAH

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TO ALL PARTIES:

If you disagree with a decision of the juvenile court judge in a child welfare case, you have a right 

to appeal that decision to the Utah Court of Appeals.  However, you must know and follow the rules, 
which have these strict deadlines and requirements:

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To appeal the juvenile court’s order you must file a Notice of Appeal in the juvenile court within
15 days of entry of the judge’s written decision.

Although your attorney will likely prepare the Notice of Appeal, you must sign it. Otherwise, the
Notice of Appeal will not be valid, and your appeal will be terminated.

During the appeal you must keep in regular contact with your attorney.  Let your attorney know
your current address and telephone number, and promptly notify your attorney if these change.
You must also give this information to the other parties in the case and to the appellate court.

Rec’d by:____________________________Signed:___________________________Date:____________

Print Party’s Name

Party’s Signature

Address: _________________________________________ State:_______________ ZIP ____________

 ______________________________ Counsel for ___________________Date:________

Counsel’s Signature

Note:  If a party does not sign this statement, a copy must be mailed by the court to the party at his/her last 
known address.  See Utah Code Ann. § 78A-6-359(4). 

I certify that on _______ I mailed a copy of this form, with first-class postage prepaid, to the following: 

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      Party’s Name

      ZIP   

Address

  State

____________________________________________

    Clerk