Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 1 of 9 (optional form) Superior Court of the State of California County of Kings GUARDIANSHIP QUESTIONNAIRE (For relative cases) FOR COURT USE ONLY (RECEIVED ON): Case Number: Hearing date (if applicable): Instructions to Petitio ner: The questionnaire is important in introducing you and your situation to the investigator handling your case. Attach additional pages , as needed . In order to begin the investig ation ordered by the Court, each petitioner must complete a questionnaire a nd return it , along with your completed investigation packet to either : KINGS COUNTY SUPERIOR COURT 1640 Kings County Drive Hanford, CA 93230 Attention: Probate Clerk Name of Child (1): DOB: Address of Child (1): Name of Child (2): DOB: Address of Child (2): Name of Child (3): DOB: Address of Child (3): Name of Child (4): DOB: Address of Child (4): Proposed Guardian Information Name of Proposed Guardian: Other Names Used: Relationship to Child: Age: DOB: Place of Birth: Address: City: Stat e: Zip: Home Phone: Business Phone: Sex: Height: Weight: Eyes: Hair: American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 2 of 9 Provide previous residential history (Past 10 years): Natural Mother of Child Name: Current or last known Address: City: State: Zip: Phone: Heig ht: Weight: Eyes: Hair: DOB: Place of Birth: Date and location of last contact with child: Natural Father of Child (1) Name: Current or last known Address: City: State: Zip: Phone: Height: Weight: Eyes: Hair: License No. DOB: Place of Birth: Date and location of last contact with child: Natural Father of Child (2) Name: Current or last known Address: City: State: Zip: Phone: Height: Weight: Eyes: Hair: DOB: Place of Birth: Da te and location of last contact with child: Natural Father of Child (3) Name: Current or last known Address: City: State: Zip: Phone: Height: Weight: Eyes: Hair: DOB: Place of Birth: American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 3 of 9 Date and location of last contact with ch ild: Natural Father of Child (4) Name: Current or last known Address: City: State: Zip: Phone: Height: Weight: Eyes: Hair: DOB: Place of Birth: Date and location of last contact with child: Other Children of Mother or Fathe r Name: Age: DOB: Living with whom? Employment Data of Proposed Guardian Occupation: If unemployed, what are your employment plans? Present or last employer: Address: Work days & hours: Employment began: Ended: Previous Employer: Employment began: Ended: Marital History of Proposed Guardian (List all marriages) Name (To Whom) Date & Place How Terminated (Divorce, Death) Date Separated Final Was there ever any domestic violence in any of the marriages? Yes No If yes, please explain: American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 4 of 9 (Include adult children, first & last names) Name (list all) Age DOB (If different than parent) Do a Protective Services? Yes No If yes, please explain: Education High School graduate? Year: Name of school : If no t, grade last attended: Reason for leaving: College or University Attended Degree/Units Major Health Insurance: Present health status: Good Fair Poor If fair or poor, please ex plain: Have you ever had a substance abuse problem with any of the following? Alcohol Yes No Drugs Yes No If yes to any of the above, please explain: List all medications currently taking: American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 5 of 9 Criminal Record Have charges ever been filed against you for any crime other than a traffic violation? Yes No If yes, please specify: List Arrests Where When Charge Are you currently on Probation? Are you currently on Parole? Have you ever been involved with Child Protective Services? Yes No If yes, please explain: Family Func tioning of Proposed Guardian What types of activities do you participate in as a family? Housing How many bedrooms? House Apartment Plans for Child Care (If needed) Name: Address: P hone: Relationship to child: Hours Name: Address: Phone: Relationship to child: Hours Others in Household Name DOB Relation to Guardian Number Social Security Number American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 6 of 9 Minor (1) History Profession al Practitioners (Medical doctors, psychiatrists, psychologists, counselors, social workers, etc.) Name & Title Last Contact Address Phone Good Fair Poor If fair or poor, please explain: Special health problems: Minor (2) History Professional Practitioners (Medical doctors, psychiatrists, psychologists, counselors, social workers, etc.) Name & Title Last Contact Address Phone Good Fair Poor If fair or poor, please explain: Special health problems: Minor (3) History Professional Practitioners (Medical doctors, p sychiatrists, psychologists, counselors, social workers, etc.) Name & Title Last Contact Address Phone Good Fair Poor If fair or poor, please explain: Special health problems: American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 7 of 9 Minor (4) History Professional Practitioners (Medical doctors, psychiatrists, psychologists, counselors, social workers, etc.) Name & Title Last Contact Address Phone : Good Fair Poor If fair or poor, please explain: Special health problems: School of Child (1) Is the minor currently enrolled in school? Yes No If yes, where? What grade? Submit copy of most recent report card. Does the minor participate in extracurricular activities? Yes N o If yes, what activities? School of Child (2) Is the minor currently enrolled in school? Yes No If yes, where? What grade? Submit copy o f most recent report card. Does the minor participate in extracurricular activities? Yes No If yes, what activities? School of Child (3) Is the minor currently enrolled in school? Yes No If yes, where? What grade? Submit copy of most recent report card. Does the minor participate in extracurricular activities? Yes No If yes, what activities? American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 8 of 9 School of Child (4) Is the minor currently enrolled in school? Yes No If yes, where? What grade? Submit co py of most recent report card. Does the minor participate in extracurricular activities? Yes No If yes, what activities? Summary of Views Please summarize your views and concerns as clearly as possible on th e following pages. Please attach additional pages as necessary. Please reference the question number on additional pages. 1. Why are you seeking guardianship of the child? 2. If the child lives with you, when did you retaker ? Do the American LegalNet, Inc. www.FormsWorkFlow.com Kings County Local Form Optional Use GS5 Guardianship Questionnaire (relative cases) local form revised on 10. 26 .18 Page 9 of 9 3. Is there anyone who opposes your guardianship? Please explain. 4. How do you plan to discipline the child? 5. If you are a grandparent seeking gua rdianship, what would you do differently in raising this grandchild to prevent the same problems that happened with your own children? 6 . get their children back ? Date : / / (print name of proposed guardian) ( Signature of proposed guardian ) American LegalNet, Inc. www.FormsWorkFlow.com