• GAL Parent / Legal Guardian Intake Questionnaire

    Please answer as the parent or guardian completing this form. The guardian ad litem (GAL) represents the minor child or children. Use your own words. If you do not know an answer, say so. For answers involving more than one child, identify which child you mean.
  • As a family law practice, we always prefer to put a face with a name. If you would like, share the photo of yourself that you like most. It can be of just you, or of you with your child or children. This is completely optional.
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  • Parent/Guardian Information

  • Preferred method of contact
  • Format: (000) 000-0000.
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Who filed the court papers?

  • A petition or motion is a written request asking a court to make an order. Tell us who filed the papers and what they asked for. You do not need to know the legal name of a filing. If there is more than one filing, describe each one in the additional-filings box.

  • Have you filed a petition or motion involving the child?
  • What did you file?
  • Has another person or agency filed papers involving the child?
  • What did the other person or agency file?
  • When were the court papers filed, if you know?
     - -
    2 digit month, 2 digit day, 4 digit year
  • What kind of GAL matter is this?
    • CHINS Information 

    • Representation

    • Are you represented by an attorney in this matter?
    • Format: (000) 000-0000.

    • Accommodations

    • Do you need any accommodation to participate in this matter?
    • Do you need an interpreter or translated documents?

    • Information About the Child(ren)

    • Please list the names, birthdates, and current schools of all children for whom you are the parent or legal guardian.
    • If a child primarily lives somewhere else, does that apply here?
    • Do any of the children have special needs, medical conditions, or require accommodations?

    • Relationship to the Child(ren)

    • Please provide a recent picture of the child or children. You may send the picture separately to the GAL.
    • Are you the child's biological parent?
    • Do you claim legal custody rights?
    • Do you claim physical custody rights?
    • Are you a court-appointed guardian?
    • Are you acting in loco parentis?

    • Living Arrangements / Household

    • List all adults currently residing in your household (name, relationship to child, age, occupation).
    • Do you anticipate any changes in your household in the next 6 months?
    • Does the child have a separate sleeping space?
    • Any home safety concerns?
    • Are there firearms or weapons in the home?
    • Any pets creating safety concerns?

    • Current Legal Status / Agreements

    • Is the current arrangement working?

    • Safety Concerns

    • Are you aware of any immediate safety concern involving the child?
    • Check all that apply
    • Has the child ever been injured while in your care or the other parent's/caregiver's care?
    • Has the child witnessed violence, arrests, overdoses, or other traumatic events?
    • Does the child fear any person or place?
    • Is there a current safety plan?

    • Prior Litigation / Prior Legal Matters

    • Check all that apply
    • Are there any founded or pending DSS/CPS findings?
    • Check all tasks you usually handle
    • Has/have the child(ren) ever lived apart from you?
    • Have you ever withheld the child(ren) from the other parent or caregiver?
    • Has the other parent or caregiver withheld the child(ren) from you?
    • Does the child have any diagnosed condition?
    • Check all that apply

    • Schooling

    • Attendance concerns?
    • Academic concerns?
    • Behavior or discipline concerns at school?
    • Bullying or peer issues?
    • Is transportation to school reliable?
    • Do you have reliable transportation?
    • Do you have any physical condition affecting caregiving?
    • Do you have any mental health condition affecting caregiving?
    • Any current treatment or medication relevant to caregiving?
    • Any substance use history relevant to caregiving or child safety?
    • Are you willing to submit to voluntary drug or alcohol screening if requested?
    • Are you an active-duty, reserve, or National Guard member of the military?
    • Do you plan to move in the next 12 months?

    • Professionals who know the child

    • Please list any professionals (teachers, counselors, doctors, etc.) who have regular contact with your child(ren).

    • Other Matters

    • Are you currently involved in any other court cases concerning the child(ren)?

    • Criminal / Protective Order / Abuse-Neglect History

    • Has there been any prior involvement with Child Protective Services (CPS) regarding the child(ren)?
    • Have you ever been arrested?
    • Have you ever been charged with a criminal offense?
    • Have you ever been convicted?
    • Is any criminal case pending now?
    • Do you have any probation, parole, or bond conditions?
    • Any incarceration history?
    • Has any protective order been entered against you or in your favor?
    • Any abuse or neglect finding involving any child?
    • Any prior child removal or termination-of-parental-rights proceeding involving any child?
    • Are you aware of any such history for any adult in your household?

    • Coparenting

    • How do you currently communicate?
    • Can you communicate about the child safely?
    • Can exchanges occur safely?
    • Do you support the child having a relationship with the other parent or caregiver if safe?
    • Do you believe supervision is necessary?

    • Documents, photographs, and other records

    • You may upload those documents, photographs, and other records here. You may add more than one file. Uploading is optional; your files are delivered securely to the guardian ad litem together with your answers.
    • Would you like to upload a file or files?*
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    • Date created
       - -
      2 digit month, 2 digit day, 4 digit year
    • Do you currently have a copy

    • People who may have helpful information

    • Witness 1
    • Do you believe a subpoena will be needed

    • Outcomes Desired

    • Check all that apply
    • Check all that apply

    • Anything else you would like us to know

    • Voluntary Authorization

    • I voluntarily authorize the release to the guardian ad litem for the minor child(ren) of the records or information identified below, to the extent permitted by law. This authorization is voluntary and may be revoked in writing, except to the extent action has already been taken in reliance on it.
    • Each item you select below is an operative grant of consent.
    • Which records or permissions do you voluntarily authorize?
    • Voluntary Authorization Date
       - -
      2 digit month, 2 digit day, 4 digit year

    • By signing below, I certify that, to the best of my knowledge, the information I have provided is true and complete. I understand that the guardian ad litem represents the interests of the minor child(ren), not me personally. I understand that my completion of this form does not create an attorney-client relationship between me and the guardian ad litem. I understand that I may supplement or correct my answers in writing.

    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Submit the completed Jotform by the deadline provided by the GAL, contact the GAL's office to schedule any requested meeting, and retain a copy of the submission confirmation.
    • Should be Empty: