Guardianship Petition Application Page 5

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C. INFORMATION ON CHILD
1. Child’s Name _______________________________________________________________
Birth Date ___________________________________Place of Birth____________________
U.S. Citizen _____ ______ If no, what Country____________________________________
YES
NO
School last attended___________________________________________________________
School plans to attend _________________________________________________________
2. Has child ever been in a foster home or removed from parental custody: if yes, give details:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
3. Has child ever been arrested or charged with a delinquent act? If so, when, where, and what was the
offense?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signature of Proposed Guardian___________________________________________________
Signature of Proposed Guardian___________________________________________________
Date____________________________________________
 

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