Custodial Party Intake & Acknowledgement Form
Custodial Party Information
Custodial Party Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child(ren) Information
Please list names and ages of all involved children.
Case Information
Other Party's Name
First Name
Last Name
Court Case Number
Court Documents
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Attorney Information
Your Attorney's Name
First Name
Last Name
Your Attorney's Email
example@example.com
Other Party's Attorney
First Name
Last Name
Guardian Ad Litem
First Name
Last Name
Guardian Ad Litem
example@example.com
Upcoming Court Dates
Parent Aide Role
Parent Aide services are intended to support the development of safe, stable, and healthy parenting dynamics that promote the best interests of the child. Services focus on strengthening positive parent-child relationships and encouraging healthy co-parenting practices. The Parent Aide may observe parent-child interactions and provide guidance related to parenting practices, child development, and age-appropriate expectations. Parent Aide services are child-focused. The Parent Aide does not serve as an advocate for either party and does not make custody determinations.
Communication of Concerns
The custodial party may communicate concerns related to the child’s safety, well-being, or parenting dynamics to the Parent Aide. Concerns should be communicated in a respectful and constructive manner so they can be appropriately reviewed and addressed when possible. Relevant information may be documented as part of Parent Aide services when it relates to the child’s well-being or parenting dynamics.
Confidentiality & Release of Information
Information shared during Parent Aide services will be treated as confidential to the extent permitted by law. Documentation related to services may be maintained and may be shared with authorized individuals involved in the custody matter when appropriate. By completing this form, the custodial party acknowledges that relevant information regarding services may be shared with authorized parties including attorneys, guardians ad litem, and the court when services are connected to custody matters or when legally required.
Custodial Party Concerns
Please describe any concerns you would like the Parent Aide to be aware of regarding the child, parenting dynamics, or visitation.
Pertinent Family History
Please provide any relevant family history, safety concerns, or information that may be important for the Parent Aide to know when working with your child.
Additional Information
Is there anything else you believe would be helpful for the Parent Aide to know regarding your child or family situation?
Acknowledgement and Signature
By signing below, the custodial party acknowledges that they have reviewed the information provided in this form and understand the role of the Parent Aide, the purpose of services, and how concerns and relevant information may be documented and communicated when services are connected to custody matters.The custodial party also certifies that the information provided in this intake form is accurate to the best of their knowledge.
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