Personal Reference Questionnaire Last revised on: 05-04-16 Page 1 of 3 Local form (optional form) Superior Court of the State of California County of Kings PERSONAL REFERENCE QUESTIONNAIRE Guardianship Guardianship Termination Step - Parent Adoption FOR COURT USE ONLY (REC EIVED ON): CASE NUMBER: Name and telephone number of the individual for whom you are completing the questionnaire: Petitioner's Name: Instructions on completing this form: In order to begin the investigation ordered by the Court, pl ease complete this questionnaire for the petitioner who is requesting the guardianship . The petitioner will submit this form, along with the investigation packet t o: KINGS COUNTY SUPERIOR COURT 1640 Kings County Drive, Hanford, CA 93230 As you answer e ach question below, please keep in mind that it is the responsibility of the Court to safeguard the welfare and future development of the children in this family. You can help the Court in meeting this responsibility by being objective and confining your statements to observations which you have personally made. Answer each question as completely as possible using additional paper if needed. The investigator may contact you personally to discuss your statement with you. Your Name: A ddress: (City, St ate and Zip Code) Home Telephone: ( ) Work Tele phone: ( ) ext. What is your r elationship to the person (petitioner) named above (relative, friend, coworker, etc.) ? How long have you known this person? How often do you have contact with the child(ren)? List the d ate you last had contact with the child(ren) : How long have you known the child(ren) in this case? How often do you have contact with them? Date you la st had contact with them: American LegalNet, Inc. www.FormsWorkFlow.com Personal Reference Questionnaire Last revised on: 05-04-16 Page 2 of 3 Local form Do you know the natural parent? No Yes, if yes , how long have you known them? PHYSICAL ENVIRONMENT H ave you been in the home of the Petitioner? If so , describe the general cleanli ness and order of the home. CARE OF THE CHILDREN Describe how the Petitioner treats, or cares for, the child ( ren ) . Describe the relationship between the individual and the child ( ren ) from your observation? Have you ever witnessed an y questionable treatment of the child ( ren ) by the Petitioner? (If so, please explain) CHILDREN State your personal observations of each child ( ren ) , including any physical or emotional issues known to you. Have the child ( ren ) expres sed their feelings about this matter to you? American LegalNet, Inc. www.FormsWorkFlow.com Personal Reference Questionnaire Last revised on: 05-04-16 Page 3 of 3 Local form PARENTS Do you know if the Petitioner has a history of: Drugs : Prescribed (for them) Illegal Alcohol : Occasiona l Frequent Criminal activities : No Yes FOR GUARDIANSHIP TERMINATIONS ONLY: Do you feel the Petitioner is a m ore appropriate caretaker than the current Guardian? ADDITIONAL COMMENTS DATE: / / (Signature) American LegalNet, Inc. www.FormsWorkFlow.com