SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RIVERSIDE 4050 Main St., Riverside, CA 92501 TEMECULA 41002 County Center Dr., #100, Temecula, CA 92591 RI - PR 094 ATTORNEY OR PARTY WITHOUT ATTORNEY ( Name, State Bar Number and Address) FOR COURT USE ONLY (CONFIDENTIAL) TELEPHONE NO.: FAX NO. (Optional): E - MAIL ADDRESS (Optional): ATT ORNEY FOR (Name ): IN THE MATTER OF: CASE NUMBER: CHARACTER REFERENCE QUESTIONNAIRE Note to Petitioner: Please provide three (3) character references. One form will be mailed by the court to each non - related reference who has knowledge of your home life and standing in the community. The character reference must complete this form and return it to the court within 10 days. It is preferred that one (1) reference be associated with the subject minor (e. g. day care provider, therapist, teacher, medical professional). Your name has been given to the court as a reference for ( name ): . Will you kindly answer the following ques tions and return the completed form to us in the enclosed envelope within 10 days. Petitioner do not complete below this line 1. How long have you known this individual? 2. How well do you know this individual? If you are related to them, how are you related? 3. How frequently have you visited the home where the minor(s) will reside? 4. How do you rate the characteristics of this individual? (excellent, acceptable, unfavorable ; explain unfavorable rati ngs under comments.) Responsibility Dependability Honesty Diligence/Industry Disposition Emotional Maturity Moral Standards Relationship to child(ren) Page 1 of 2 Adopted for Mandatory Use Riversid e Superior Court Form RI - PR 094 [Rev. 01/01/19 ] CHARACTER REFERENCE QUESTIONNAIRE Probate Code 1513 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF: CASE NUMBER: 5. To the be st of your knowledge, are they financially able to add a child to their family? 6. What do you know of their habits, homelife, and their fitness to bring up children? 7. If this individual has a spouse or significant other, do you consider their relationship to be a happy one ? Why? 8. Have you observed any physical abuse or heated arguments within the family. If yes, briefly explain and give dates. 9. To what extent does this individua l use intoxicants? (alcohol, drugs, etc.) Excessively Moderately Not at all 10. State your observations of each child subject to guardianship including any known physical or emotional problems. 11. Have the childr en expressed to you their feelings regarding the guardianship or custody? If so, please explain. 12. Please state any reasons why you believe this individual would not be desirable for the care of the child/children. 13. What special care are they giving to the child(ren) in their home? (if applicable) 14. If an occasion should arise where it would be necessary to place your own child or one in who m you are personally interest ed, would you feel satisfied to have him /her raised in this home? Why? 15. If you have any reservations about recommending the individual , would you like to discuss questions with our investigator? For additional commen ts use a separate attachment if necessary: Signature: Date: Phone number: Page 2 of 2 Adopted for Mandatory Use Riverside Superior Court Form RI - PR 094 [Rev. 01/01/19 ] CHARACTER REFERENCE QUESTIONNAIRE Probate Code 1513 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com