Guardian222s Report/ Guardianship of the Person of a Minor PC - 570 REV. 4 /19 CONNECTICUT PROBATE COURTS CONFIDENTIAL Guardian222s Report/Guardianship of the Person of PC-570 Page 1 of 3 RECEIVED: Instructions: 1) A guardian of the person of a minor (other than a parent) may use this form to report to the Probate Court at least annually on the condition of the minor. 2)The guardian should respond to every question. If a question does not apply, the guardian may indicate223Not Applicable224 or 223N/A.224 3)For more information, see C.G.S. section 45a-625.4)Type or print the form in ink. Use an additional sheet, or PC-180, if more space is needed. Probate Court Name District Number In the Matter of Hereinafter referred to as the minor Present Address and Telephone Number of the Minor Minor222s Date of Birth Guardian (Name, present address and telephone number) Guardian (Name, present address and telephone number) Check here if new address . Check here if new address . Parent (Name, present address and telephone number) Parent (Name, present address and telephone number) Check here if new address . Check here if new address . The guardian222s report is being filed for the following reason: Annual report Other (Specify.): Court - ordered report Please respond to the following questions for the period since the last guardian222s report was filed in court, or if this is the first report, since your appointment as guardian . 1. Is the minor in day care, pre-school or school?Yes NoIf yes, provide the name of the day care, pre-school or school: Specify grade, if applicable Describe how the minor is doing in school (behavior, grades, etc.) and anything that has changed significantlyduring the last school year. 2. American LegalNet, Inc. www.FormsWorkFlow.com Guardian222s Report/ Guardianship of the Person of a Minor PC - 570 REV. 4 /19 CONNECTICUT PROBATE COURTS CONFIDENTIAL In the Matter of Guardian222s Report/Guardianship of the Person of a Minor PC-570 Page of 3 3.Have any major changes happened during the last year that affected the minor?Yes No If yes, please describe any change s and how the change s ha ve affected the minor: 4. Does the minor visit with the parents or other relatives? Yes NoIf yes, how often does the minor visit with each parent or relative ? (Specify name of parent or relative, relationshipand number of visits per month.) Please describe any issues or concerns with visitation: 5.Describe the minor222s relationship with any brothers or sisters who live apart and whether they visit each other. 6.Describe any issues or concerns you have caring for the minor. 7.Does the minor have medical insurance?Yes No 8. Describe any medical or psychological conditions the minor has. American LegalNet, Inc. www.FormsWorkFlow.com Guardian222s Report/ Guardianship of the Person of a Minor PC - 570 REV. 4 /19 CONNECTICUT PROBATE COURTS CONFIDENTIAL In the Matter of Guardian222s Report/Guardianship of the Person of a Minor PC-570 Page of 3 9. Describe any programs or services you are us ing to meet the minor222s needs, if any. ( For example, medication, counseling, special education, extended day care.) Are you able to obtain these or other services? Yes No 10.Describe any financial assistance you are receiving on behalf of the minor from any governmental or privateagency. Signature of Guardian of the Person Type or Print Name Date Signature of Guardian of the Person Type or Print Name Date American LegalNet, Inc. www.FormsWorkFlow.com