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Annual Guardians Report Form. This is a Oregon form and can be use in Marion Local County.
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Tags: Annual Guardians Report, Oregon Local County, Marion
IN THE CIRCUIT COURT OF THE STATE OF O REGON
FOR THE THIRD JUDICIAL DISTRICT
Juvenile Department
IN THE MATTER OF:
___________________________________________,
A Child.
)
) Case No. __________________________
)
) ANNUAL GUARDIAN'S REPORT
)
I am the guardian for the above-named child, and I make the following annual report to the court as
required by law.
I.
.
GUARDIAN INFORMATION
Name (please print):
Address:
(Street Address, City, State, Zip)
Telephone or Contact Number (including area code):
II.
LOCATION OF THE CHILD
The child currently resides with me in my home: ___Yes
___No
(If “yes,” skip to section III) (If “no,” provide the following information)
The child is living with (Please print):
Address
(Street Address, City, State, Zip)
Telephone or Contact Number (including area code):
Date the child started living at this address:
(Month/Date/Year)
ANNUAL GUARDIAN'S REPORT - Page 1 of 6
OJIN: REGD
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I have had the following contact with the child at that location:
Explanation of why the child is not now living with me:
III.
CHILD’S WELL-BEING
Physical Health
Current condition: _____________________________________________________________________
Provider name(s):
Services provided during the last year:
Emotional/Mental Health
Current condition: _____________________________________________________________________
Provider name(s):
Services provided during the last year:
Dental Health
Current condition: _____________________________________________________________________
Provider name(s):
Services provided during the last year:
ANNUAL GUARDIAN'S REPORT - Page 2 of 6
OJIN: REGD
FC (7/11/05)
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IV.
CHILD’S ACTIVITIES
The child is currently engaged in the following programs and activities and receiving the following
services:
The child has enjoyed the following hobbies or recreational interests during the past year:
The child’s school attendance and performance during the last year are as follows: (Attach a copy of the
child’s most recent report card to this report.)
The child experienced the following achievements and/or special challenges during the last year:
V.
CONTACT WITH PARENT(S)/SIBLINGS/OTHER FAMILY MEMBERS
The parent(s) visited or attempted to contact the child during the past year as follows:
The child’s reaction to those visits or attempted contacts was:
ANNUAL GUARDIAN'S REPORT - Page 3 of 6
OJIN: REGD
FC (7/11/05)
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I have the following issues of concern related to contact with the parent(s):
The child had the following contact with siblings/other family members:
VI.
DECISIONS MADE BY THE GUARDIAN
I made the following major decisions on the child's behalf during the past year:
VII.
LEGAL STATUS OF THE GUARDIAN
Since my last report:
I, or other members of the household, have / have not been convicted of the following crimes
(not including traffic violations): (Please indicate the name of the applicable person(s).)
I have / have not filed for or received protection from creditors.
I have / have not had a professional or occupational license revoked or suspended. If yes,
explain:
ANNUAL GUARDIAN'S REPORT - Page 4 of 6
OJIN: REGD
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I have / have not had my driver's license revoked or suspended. If yes, explain: _______________
Since my last report, I have delegated the following powers over the child for the following periods of
time:
Name(s):
VIII.
Powers delegated:
COMMENTS BY THE GUARDIAN
The guardianship ( should / should not) continue because:
Additional Comments:
Dated this
day of
,
20
.
Guardian’s Signature
STATE OF OREGON
County of ____________
)
)
I, _____________________________, being first duly sworn, say that the above statements are true:
___________________________________
Guardian’s Signature
SIGNED AND SWORN to before me this ___________ day of _______________, 20 _____.
____________________________________
Notary Public for ____________/Court Clerk
My Commission Expires: _______________
ANNUAL GUARDIAN'S REPORT - Page 5 of 6
OJIN: REGD
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FOR COURT USE:
COURT RESPONSE TO GUARDIAN’S REPORT
This guardian’s report of _______________, was reviewed this _____ day of _____________, 20 _____.
(date of report)
_______________________________
JUDICIAL OFFICER
No hearing needs to be set in this case at this time.
The Court by separate order directs the Citizen Review Board to review this case.
The Court is setting a hearing for review of the guardianship on _________________, 20___,
at __________ AM / PM.
Other:
cc:
Mother
Mother’s Attorney
Father
Father’s Attorney
CRB
Guardian(s)
Guardian’s Attorney
Child’s Attorney
Docket Clerk
OTHER:
ANNUAL GUARDIAN'S REPORT - Page 6 of 6
OJIN: REGD
FC (7/11/05)
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