RULE 6.2A                                               
            PETITION FOR FOURTEEN-DAY COMMITMENT                                 
                         OF MINORS                                               
                                                                                 
    The petition for 14-day commitment of a minor shall contain the              
following:                                                                       
    (a) The names and addresses of the petitioners. The petitioners shall        
be two physicians or one physician and one mental health professional.           
    (b) The name, address, age, and sex of the respondent minor.                 
    (c) The name, address and telephone number, if known, of every person        
believed by the petitioner to be legally responsible for the minor.              
    (d) A statement that the minor is or is not in detention at the time         
the petition is filed, and, if so, the name and location of the place of         
detention.                                                                       
    (e) A statement that the minor, as a result of mental disorder,              
presents a likelihood of serious harm to him/herself or others, or is            
gravely disabled.                                                                
    (f) A statement that the minor has been advised of the need of               
voluntary treatment but has been unwilling or unable to consent to               
necessary treatment.                                                             
    (g) The facts upon which the allegations of the petition are based.          
    (h) A statement concerning whether an alternative less restrictive than      
inpatient treatment is in the best interest of the minor.                        
    (i) The name and location of the facility in which respondent will be        
detained and a statement that such facility is certified by the Department       
of Social and Health Services to provide evaluation and treatment to             
persons under 18 years of age suffering from mental disorders.                   
    (j) A statement recommending the appropriate facility or facilities to       
provide the necessary treatment.                                                 
    (k) A demand that a hearing be held to determine whether the minor           
shall be committed to inpatient treatment or whether an alternative less         
restrictive treatment exists.                                                    
    (l) The petition shall be in substantially the following form:               
                                                                                 
                SUPERIOR COURT OF WASHINGTON                                     
                FOR (_______________) COUNTY                                     
                                                                                 
In re the Detention of:   )               No. __________                         
                          )                                                      
                          )               PETITION FOR FOURTEEN-                 
                          )                   DAY COMMITMENT                     
                          )                     OF A MINOR                       
                          )                                                      
     Respondent.          )               RCW 71.34.070                          
                                                                                 
    (Petitioners) are (physician) and (physician/mental health                   
professional). Petitioners' addresses are ____________________________           
                                          ____________________________           
    (Respondent), residing at (address) in (city or town), Washington, is a      
___ male ___ female years of age.                                                
    The name, address and telephone number of every person believed              
by the petitioner to be legally responsible for the minor:                       
______________________________________________________________________           
______________________________________________________________________           
    At the time of filing this petition, respondent ___ is ___ is not in         
detention pursuant to RCW 71.34. If respondent is in detention, the name         
and location of the facility in which respondent is in detention are             
_________________________________________________________________.               
    Respondent, as a result of mental disorder, ___ presents a likelihood        
of serious harm to him/herself, ___ presents a likelihood of serious harm        
to others, ___ is gravely disabled.                                              
    That the minor has been advised of the need for voluntary treatment and      
is unwilling or unable to consent to necessary treatment.                        
    The facts upon which the allegations of this petition are based              
are: _________________________________________________________________           
______________________________________________________________________           
    The following alternative courses of treatment have been considered:         
______________________________________________________________________           
    No alternative less restrictive than detention is in the best interest       
of the respondent.                                                               
    The facility in which respondent will be detained is (name and               
location), certified by the Department of Social and Health Services to          
provide evaluation and treatment to persons under 18 years of age suffering      
from mental disorders.                                                           
    Recommended treatment facilities: _______________________________            
                                       Name                                      
                                       _______________________________           
                                       Address                                   
    The petitioner(s) request(s) that a hearing be held in the above named       
court to determine whether respondent shall be involuntarily committed to        
inpatient care or whether there shall be an alternative less restrictive         
treatment pursuant to RCW 71.34.                                                 
    Dated this _______ day of ____________________, 19____.                      
                             _________________________________________           
                                          Petitioner (MD)                        
                             _________________________________________           
                                          Petitioner (MD/MHP)                    
    Sworn and Subscribed on _________________________________________            
                             _________________________________________           
                             Notary Public for the State of Washington           
                             Residing at _____________________________           
                             My commission expires on ________________