SUPERIOR COURT OF THE STATE OF WASHINGTON FOR WHATCOM COUNTY In re the Marriage of No. Petitioner ORDER APPOINTING GUARDIAN AD LITEM ON BEHALF OF MINOR (ORAPGL) and Respondent I. BASIS 1.1 CHILDREN TO WHOM THE ORDER APPLIES. The [ ] petitioner [ ] respondent [ ] court moved for appointment of a guardian ad litem for the following minor child(ren) in this action: Name 1.2 Birthdate / / / / / / / / / / BASIS FOR THE APPOINTMENT. This appointment is being made pursuant to [] [] [] RCW 26.09 Dissolution RCW 26.10 Non-Parental Custody RCW 26.26 Parentage Act [] RCW 26.33 Adoption [ ] RCW 26.44 Abuse of Children [ ] RCW 26.50 Domestic Violence II. FINDINGS After reviewing the case record to date and the basis for the motion, the Court FINDS that the motion should be granted because of the serious nature of the allegations which, if true, could have harmful consequences for the parties' minor child(ren). ORDER APPOINTING GUARDIAN AD LITEM WPF DR 04.0200 (7/93) RCW 26.09.110; .140; .220. Page 1 American LegalNet, Inc. www.USCourtForms.com III. ORDER IT IS ORDERED THAT: 3.1 APPOINTMENT OF GUARDIAN AD LITEM. is appointed as guardian ad litem for the minor children of the parties. 3.2 DUTIES OF THE GUARDIAN AD LITEM. The guardian ad litem shall: have access to all Superior Court files and all Juvenile Court files, including any sealed/confidential portions thereof. The clerk of the court shall provide certified copies of this order to the guardian ad litem upon request and without charge; be entitled to notice of all court proceedings; have access to the minor child(ren) and information about the child(ren). Each party and their counsel shall cooperate fully in providing access to the guardian ad litem and in providing all requested information; have access to all school, medical, therapy and counseling records and information, whether written or oral, regarding this child/children, if the child is under the age of 12. These records shall be released directly to the guardian ad litem upon presentation of a copy of this Order either in person or by mail. The guardian ad litem shall have access to the medical, therapy and counseling records of the parents only if there is an allegation of sexual abuse of the child or neglect and there is a separate court order allowing such access; have access to all Child Protection Services and Department of Social and Health Services records regarding these parties and their child/children without further written release by either parent upon presentation of this Order to these agencies. However, these agencies may blackout names and identification of such individuals who are protected by law or agency policy as confidential sources. If it is determined by the agency that release of this information is likely to cause severe psychological or physical harm to the juvenile or his or her parents, the agency may withhold the information subject to other orders of the court. CPS and DSHS personnel are authorized to speak personally with the guardian ad litem; have access to all police reports regarding these parties and their child(ren). Written copies of these items shall be released to the guardian ad litem upon request by the following law enforcement agencies . However, these agencies may black out names and identification of such individuals who are protected by laws or agency policy as confidential sources; maintain any information received as confidential and shall not disclose said information except in oral or written reports to the court, the parties and their counsel; and make a full and complete written report to the court and counsel/parties containing recommendations and the reasons for those recommendations regarding the matters set out below, and on or before the dates and times set out below: [ ] Interim Report On or before an interim report shall be prepared to guide the court in determining temporary residential placement of the child/children, and addressing the following issues: ORDER APPOINTING GUARDIAN AD LITEM WPF DR 04.0200 (7/93) RCW 26.09.110; .140; .220. Page 2 American LegalNet, Inc. www.USCourtForms.com [ ] a. The temporary placement of the child or children, including specific recommendations concerning the contact, conditions or restrictions on contact between the child or children and either or both parents. [ ] b. Recommended counseling, treatment, or therapy to be required of the child/children or either parent during the pendency of this action. [ ] c. . [ ] Final Report Not less than two weeks prior to trial in this matter a final report shall be prepared to guide the court in determining permanent residential placement of the child/children and recommending the extent and type of contact between the child/children and either or both parents, including specific recommendations on the matters listed below: . 3.3 OTHER DUTIES. Other duties of the guardian ad litem include appearing at all court hearings and pretrial conferences unless excused by the court and assisting the parties and counsel in reaching a resolution of the matters involving said child/children. If resolution is reached, the guardian ad litem shall assist counsel in drafting a proposal for presentation to the court for approval along with the guardian ad litem's report. 3.4 PAYMENT OF FEES AND COSTS. The fees and costs of the guardian ad litem shall be paid as follows: [] % by petitioner and % by respondent. [ ] Other: The total amount awarded shall be at the discretion of the court after the guardian ad litem files an itemized statement of time with the court, along with a specific request for fees and a proposed Order. 3.5 CONSENT OF CHILDREN OVER TWELVE TO INVESTIGATION. [ ] Does not apply. [] has/have reached the age of twelve. Consent to the guardian ad litem consulting with and obtaining information from medical, psychiatric, or other experts who have served the child(ren) in the past [ ] has been given. [ ] has not been given. 3.6 AUTHORIZATION FOR RELEASE OF INFORMATION. [ ] Does not apply. ORDER APPOINTING GUARDIAN AD LITEM WPF DR 04.0200 (7/93) RCW 26.09.110; .140; .220. Page 3 American LegalNet, Inc. www.USCourtForms.com [ ] Each party's signature hereunder constitutes an authorization for release of information by that party. 3.7 OTHER: . Dated: Judge/Commissioner Presented by: Approved for Entry/Notice of presentation waived: Signature Signature Print or Type Name Print or Type Name Accepted Upon Approval by the Court Signatures of the Parties Guardian Ad Litem Mother's Signature Father's Signature Child's Signature (See Paragraph 3.5) Child's Signature (See Paragraph 3.5) ORDER APPOINTING GUARDIAN AD LITEM WPF DR 04.0200 (7/93) RCW 26.09.110; .140; .220. Page 4 American LegalNet, Inc. www.USCourtForms.com