Annual Guardian222s Report (Juvenile) Page 1 of 7 (Apr 2019) THE CIRCUIT COURT OF THE STATE OF OREGON Annual Guardian222s Report Information (Juvenile Case) Thank you for making a commitment to this child by accepting the responsibilities of guardian. Oregon law requires you to file a report each year with the court about each child in your care. You must file the report every year until the court ends the guardianship, or the child reaches age 21. Please fill out both the Guardian222s Report and the Summary Sheet that are enclosed. Mail or deliver them to the court. You should make copies of the blank documents so you can fill them out every year. You may include additional pages if you need to. The report is very important. The Judge will read your report and may refer the case to the Citizen Review Board for further review. If no report is received, you may have to go to court to explain why you did not file the report. You must say under oath that the information in the report is true. Remember: You cannot place this child in the care or custody of any other person without the Judge222s permission. Ask the court in writing before you place the child with another person. You also must make sure the court has your current address at all times. If you decide to move, let the court know your new address before the move by sending a letter to the court with your case number. The Judge may set a hearing. If a hearing is set, the court will send you a notice with a hearing date and time. Please talk to a lawyer if you have questions about your duties or rights as a guardian. Thank you for keeping your promise to provide a safe and supportive home for this child. IMPORTANT NOTICE: If you are receiving guardianship assistance through the Department of Human Services (DHS) and want to continue receiving payments after the child turns 18 years of age, you must submit a request for an extension to DHS at least 30 days before the child222s 18th birthday. REMEMBER to fill out the county name at the top of each form American LegalNet, Inc. www.FormsWorkFlow.com Annual Guardian222s Report (Juvenile) Page 2 of 7 (Apr 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of: Case No: GUARDIAN222S ANNUAL REPORT SUMMARY SHEET A child I am the guardian for (child222s name): I submit the attached Guardian222s Annual Report dated to comply with my annual reporting requirement. Date Signature Name (printed) American LegalNet, Inc. www.FormsWorkFlow.com Annual Guardian222s Report (Juvenile) Page 3 of 7 (Apr 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of: Case No: GUARDIAN222S ANNUAL REPORT A child Guardian222s Information: Name: Address: Phone: Information regarding the child since the last report: 1. The child currently resides with me in my home or as follows: a. With (name): b. Address: c. Contact Phone (include area code): d. Since (date): e. Explanation of why the child is not living with me: 2. The child222s physical condition is as follows: (brief description) a. Names of doctors or health care providers the child has seen in the past year: b. Medical treatment or reasons for hospital/medical visits during the last year: American LegalNet, Inc. www.FormsWorkFlow.com Annual Guardian222s Report (Juvenile) Page 4 of 7 (Apr 2019) 3. The child222s emotional and mental condition is as follows: (brief description) a. Names of psychologists, psychiatrists, counselors, or therapists the child has seen in the past year: b. Treatment or reasons for counseling or therapy during the last year: 4. The child222s dental condition is as follows: (brief description) a. Names of dentists or dental care providers the child has seen in the past year: b. Services or reasons for dental treatment or visits during the last year: 5. The child is currently engaged in the following non - school - related programs and activities : American LegalNet, Inc. www.FormsWorkFlow.com Annual Guardian222s Report (Juvenile) Page 5 of 7 (Apr 2019) a. The child has enjoyed the following hobbies or recreational interests during the past year: 6. The child 222s school attendance and performance are as follows (attach a copy of the most recent report card to this report) : 7. The child experienced the following activities , achievements and/ or special challenges during the last year: 8. Family Contact a. The parents visited or attempted to contact t he child during the past year as follows: b. The child reacted to the visits or contact attempts as follows: c. I have the following issues of concern related to contact with the parents: American LegalNet, Inc. www.FormsWorkFlow.com Annual Guardian222s Report (Juvenile) Page 6 of 7 (Apr 2019) d. The child had the following contact with siblings or other family members: 9. I made the following major decisions on behalf of the child during the past year: Since my last report, I have or a member of my household has: (include names) 10. had a driver222s license revoked or suspended (explain): 11. been convicted of the following crimes, not including traffic violations: (list the crime and person convicted) 12. filed for or received protection from creditors (explain) 13. had a professional or occupational license revoked or suspended (explain): 14. I delegated powers over the child as follows: a. Name of person delegated to: b. Powers delegated: c. For how long: I believe the guardianship should should not continue because: American LegalNet, Inc. www.FormsWorkFlow.com Annual Guardian222s Report (Juvenile) Page 7 of 7 (Apr 2019) I ask the court to schedule a hearing to review the guardianship (explain): Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help A legal help organization helped me choose or complete this form, but I did not pay money to anyone I paid (or will pay) for help choosing, completing, or reviewing this form I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use in court and I am subject to penalty for perjury. Date Signature Name (printed) American LegalNet, Inc. www.FormsWorkFlow.com