IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT STATE OF ILLINOIS COUNTY OF WINNEBAGO Plaintiff vs. Defendant. ] ] ] ] ] ] ] No. _____ D ____________ ORDER APPOINTING GAL/CHILD REPRESENTATIVE (Strike out the designation that does not apply) This cause coming before the court this date, and it appearing to the court that the issues presented would benefit from the appointment of a GAL/Child Representative pursuant to 750 ILCS 5/506, and the court having jurisdiction over the parties and the subject matter, IT IS ORDERED 1. That Attorney ___________________, located at ___________________________ , phone__________________ is appointed by the court as the GAL/Child Representative for the minor child(ren) herein. 2. That the GAL/Child Representative shall receive the amount of $_____________ as initial retainer. Plaintiff shall be responsible for _______________, and Defendant shall be responsible for the balance. The parties shall pay their respective amounts within 30 days unless they arrive at alternative written arrangements with the GAL/Child Representative. 3. The parents are ordered to execute releases of information to the GAL/Child Representative concerning all medical, scholastic, counseling, or other potentially confidential materials concerning the child(ren), and to cooperate with the GAL/Child Representative in scheduling necessary appointments to assist in the completion of the investigation. Pursuant to Supreme Court Rule 907, the GAL/Child Representative shall be allowed access to the child and all relevant documents. The child(ren) presently reside with______________________. The mother of the child(ren) is The father of the child(ren) is: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ (Address and Telephone) (Address and Telephone) 4. This case is set for ________________, on _______________, 200__ at ______ o’clock Date: ____________________ ENTER: ____________________ Judge Approved: ____________________ Attorney for Mother ____________________ Attorney for Father APPENDIX JJ American LegalNet, Inc. www.FormsWorkflow.com