Name

County Attorney

Address

City, State, Zip

Telephone Number

Attorney for Plaintiff

IN THE YOUTH COURT

OF THE JUDICIAL DISTRICT OF THE STATE OF MONTANA

IN AND FOR THE COUNTY OF

*

IN THE MATTER OF * Cause No.

*

* JUDGE

*

DOB: * CONSENT AGREEMENT

*

* * * * * * * * * * WITHOUT PETITION

The following Agreement is understood and consented to as being in the best interest of the public and , the (son/daughter) of (parents names) , of

(address) .

That the youth is a (youth in need of supervision as defined by Section 41-5-103 (14) / delinquent youth as defined by Section 41-5-103 (13) ) because (facts constituting needs for supervision or delinquency) .

That the youth and (his/her) parent(s) acknowledge the jurisdiction of the youth court for the Judicial District.

Therefore the youth and (his/her) parent(s) agree that it is in the best interest of the youth to be placed in a child care agency for substitute care or a private agency responsible for care and rehabilitation as determined by the Department of Family Services.

The youth and (his/her) parent(s) consent to a review by the Youth Placement Committees to determine the appropriate placement for the youth.

Once the Department of Family Services has determined placement of the youth, the parties to this Agreement will enter into a new Consent Agreement.

OR

(INSERT A) That the Youth Placement Committee for the

Judicial District has reviewed this case and recommended placement at , this placement has been approved by the Regional Administrator of the Department of Family Services. The youth and (her/his) parent(s) agree that the placement is the best interests of the youth.

OR

(INSERT B) This Agreement is for a period beginning on the day of , 19 , until the day of , 19 , unless sooner legally discharged.

OR

(INSERT C) The youth and (his/her) parent(s) understand that a violation of the terms of this Agreement may result in a formal petition being filed with the Youth Court alleging the youth is a delinquent youth by reason of the violation of the provision of this agreement.

The undersigned have read and approved this Agreement.

DATED this day of , 19 .

Youth Name

County Attorney

Parent Youth Probation Officer

Parent Judge