RULE 6.1A                                               
         PETITION FOR INITIAL DETENTION OF A MINOR                               
                                                                                 
    The petition for initial detention shall contain the following:              
    (a) Identification of the petitioner as a designated mental health           
professional.                                                                    
    (b) A statement describing the circumstances under which the condition       
of the respondent was brought to the petitioners attention.                      
    (c) A statement that as a result of the petitioners personal                 
observation or investigation, the petitioner believes that the actions of        
the respondent constitute a likelihood of serious harm to the respondent,        
others, or to the property of others, or that the respondent is gravely          
disabled.                                                                        
    (d) A statement of the specific facts known to the petitioner upon           
which he bases his belief that respondent should be detained for the             
purposes and under the authority of RCW 71.34.                                   
    (e) A request that the respondent be detained at an evaluation and           
treatment facility for no more than a 72-hour treatment and evaluation           
period.                                                                          
    (f) A statement that voluntary admission for inpatient treatment is not      
possible.                                                                        
    (g) The date and the signature of the petitioner.                            
    (h) The petition shall be in substantially the following form:               
                                                                                 
                SUPERIOR COURT OF WASHINGTON                                     
                FOR (_______________) COUNTY                                     
                                                                                 
In re the Detention of:   )                                                      
                          )               No. __________                         
                          )                                                      
Petitioner:               )               PETITION FOR INITIAL                   
and                       )               DETENTION OF A MINOR                   
                          )                                                      
Respondent:               )               RCW 71.34.050                          
                                                                                 
    Pursuant to RCW 71.34 petitioner, a mental health professional               
designated by the county, alleges under penalty of perjury that:                 
    Respondent, _______________, was brought to my attention under               
the following circumstances: _________________________________________           
______________________________________________________________________           
______________________________________________________________________           
    As a result of my personal observation or investigation I believe that       
the actions of the respondent constitute a likelihood of serious harm or         
that the respondent is gravely disabled.                                         
    The specific facts known to me as a result of personal observation or        
investigation, upon which I base the belief that the respondent should be        
detained for the purposes and under the authority of RCW 71.34 are:              
______________________________________________________________________           
______________________________________________________________________           
    Voluntary admission is not possible. Therefore the petitioner requests       
that the respondent be detained at an evaluation and treatment facility for      
no more than a 72-hour evaluation and treatment period, excluding                
Saturdays, Sundays, and holidays.                                                
    Dated this _______ day of ____________________, 19____.                      
                             _________________________________________           
                                            Petitioner                           
    Sworn and Subscribed on _________________________________________            
                             _________________________________________           
                             Notary Public for the State of Washington           
                             Residing at _____________________________           
                             My commission expires on ________________