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SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY (California)

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SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER
Form Adopted for Optional Use www.placer.courts.ca.gov
Superior Court of California, County of Placer Page 1 of 2
Form No. PL-JV006
Revised 06-21-2021
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar Number, and Address):
TELEPHONE NO.:
FAX NO.:
EMAIL ADDRESS:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER
11270 B Ave.
Auburn, CA 95603
NAME OF MINOR:
REQUEST FOR REMOTE APPEARANCE: JUVENILE
TELEPHONIC VIDEO
CASE NUMBER:
1. Please list the names/roles (minor, parent, legal guardian, foster parent, sibling, attorney, social worker,
probation officer, etc.), contact information, and hearing type(s) being submitted with this request.
Name and Role (e.g. Jane Smith, Mother): __________________________________________________
Email Address: _________________________________ Phone Number: _______________________
For hearing(s) (type and date): ___________________________________________________________
____________________________________________________________________________________
This request does not require judicial approval, pursuant to Local Rule 10.28(G).
This request requires judicial approval, and the reason for the remote appearance request is:
Name and Role (e.g. Jane Smith, Mother): __________________________________________________
Email Address: _________________________________ Phone Number: _______________________
For hearing(s) (type and date): ___________________________________________________________
____________________________________________________________________________________
This request does not require judicial approval, pursuant to Local Rule 10.28(G).
This request requires judicial approval, and the reason for the remote appearance request is:
Name and Role (e.g. Jane Smith, Mother): __________________________________________________
Email Address: _________________________________ Phone Number: _______________________
For hearing(s) (type and date): ___________________________________________________________
____________________________________________________________________________________
This request does not require judicial approval, pursuant to Local Rule 10.28(G).
This request requires judicial approval, and the reason for the remote appearance request is:
A page with additional names and contact information is attached to this form.
SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER
Form Adopted for Optional Use www.placer.courts.ca.gov
Superior Court of California, County of Placer Page 2 of 2
Form No. PL-JV006
Revised 06-21-2021
2. I have read the advisements of this form and applicable local rules regarding remote appearance
requirements.
• I understand that the court, in its discretion, may decide to terminate the remote appearance if it is
determined during the hearing that I am not available at the time of calendar call, or there is a
delay due to disruption, noise, misconduct, a communication problem, a technical problem, or
other issue.
• I understand that the court may decide at any time to require a personal appearance and continue the
hearing.
• I assume the risk of cost, time, delay, technical failure, a wrong number, and/or other issues that
may arise out of this remote appearance.
• I understand that except as provided in California Rules of Court, rule 1.150, court proceedings
shall not be photographed, recorded, or broadcast.
• I understand Juvenile Court proceedings are CONFIDENTIAL and only the party listed above may
appear on the telephone or video without further court approval. Violations of confidentiality are
subject to sanction.
DATE: _________________
_________
_______________________________ _______________________________________
PRINTED NAME SIGNATURE
FOR COURT USE ONLY
By Court Clerk: The request does not require judicial approval, pursuant to Local Rule 10.28(G).
Date: ______________________ Clerk __________________________________________
By Judicial Officer: The request for a remote appearance is:
GRANTED
DENIED
Date: ______________________ ___________________________________________
Judicial Officer
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SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY (California)

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Completed 15 June 2021

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