Petition For Appointment Of *guardian Of The Person And/or Conservator Of The Estate Of Minor Form Page 4
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4OTHER CHILDREN IN THE HOME
NAME:_________________________________________________________ MALE/FEMALE
BIRTHDATE:___________________________________________________AGE__________
SCHOOL:______________________________________________________GRADE:_______
AVERAGE GRADES:___________________________________________________________
NAME:_________________________________________________________ MALE/FEMALE
BIRTHDATE:___________________________________________________AGE__________
SCHOOL:______________________________________________________GRADE:_______
AVERAGE GRADES:___________________________________________________________
NAME:_________________________________________________________ MALE/FEMALE
BIRTHDATE:___________________________________________________AGE__________
SCHOOL:______________________________________________________GRADE:_______
AVERAGE GRADES:___________________________________________________________
OTHERS IN HOME
PLEASE LIST NAME, SEX, AGE, RELATIONSHIP, SCHOOL/OCCUPATION
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
ANY PRIOR HOME/CUSTODY STUDIES:
YES/NO
IF YES, EXPLAIN WHY:_______________________________________________
___________________________________________________________________________
___________________________________________________________________________
PHYSICAL SETTING – PETITIONERS HOME
ADDRESS:___________________________________________________________________
LENGTH OF TIME AT THIS ADDRESS:________________________PHONE:______________
LOCATION OF HOME/TYPE OF NEIGHBORHOOD:_____________________________________
DESCRIPTION OF HOME:_______________________________________________________
___________________________________________________________________________
NUMBER OF BEDROOMS:________________ SLEEPING ACCOMODATIONS:________________
FAMILY MOTIVATION:
AWARENESS OF CHILD’S NEEDS/PROBLEMS:_______________________________________
___________________________________________________________________________
___________________________________________________________________________
WHY DO YOU WANT TO ASSUME THIS RESPONSIBILITY?_____________________________
___________________________________________________________________________
___________________________________________________________________________
HOW DO YOUR OTHER FAMILY MEMBERS FEEL ABOUT THIS PLAN?_____________________
___________________________________________________________________________
___________________________________________________________________________
DOES PETITIONER(S) HAVE KNOWLEDGE OF ANY OTHER PARTIES SEEKING GUARDIANSHIP
OF THIS CHILD?______________ IF YES, WHOM?__________________________________
DATED:____________________ SIGNED:__________________________________________
DATED:____________________ SIGNED:__________________________________________
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