CP&P 21-31
(rev. 7/2010)
State of New Jersey
Division of Child Protection and Permanency
SAFE HAVEN NOTICE OF EMERGENCY REMOVAL
PURSUANT TO N.J.S.A. 9:6-8.29 AND 9:6-8.30
WITHOUT COURT ORDER
Date
TO:
(hospital name and address)
This is to serve as official notice that the Division of Child Protection and Permanency has been
notified by
that a
(hospital or police department name)
child,
, was brought to
(name/hospital identification number)
(hospital name)
on ____________by a caregiver pursuant to the New Jersey Safe Haven Infant Protection Act.
(date)
Pursuant to the New Jersey Safe Haven Infant Protection Act, and N.J.S.A. 9:6-8.29 and N.J.S.A.
9:6-8.30, the Department of Children and Families, Division of Child Protection and Permanency
has assumed the care, control and custody of the child. Also pursuant to this authority, the
Division can consent to the examination and treatment of the child, and medical reports resulting
from such examination or treatment shall be released to the Division. Further, any person or
health care facility acting in good faith in the examination of, or the provision of care or
treatment to, the child, or in the release of medical records shall have immunity from any
liability, civil or criminal, that might otherwise be incurred or imposed as a result of such act.
Very truly yours,
CP&P Caseworker signature
CP&P Caseworker name
NOTICE RECEIVED BY:
name of CP&P Local Office
SIGNATURE: hospital representative
CP&P Local Office address
name and title
____________________________________
date
CP&P Local Office telephone number