Dissolution (Divorce) Intake Form Page 3
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CHILDREN from Present Marriage (
)
including legal adoption
Child’s full name
Gender
Birthdate
Age
Social
Living with
Security
whom?
number
Is there a current pregnancy involved in this case? _________________________________________
Is there a dispute involving the children? _____________________________________________________
Custody Dispute? __________________________________________________________________________
Other Dispute? _____________________________________________________________________________
NOTE: By statute, in any dissolution case in which custody is contested, the parties often must
attend a court-approved parenting education program. Courts often order this even if custody
is not contested. Children are sometimes required to attend separate classes as well to help
them deal with the divorce. If required, the parties must file certificates of course completion
in order to finalize the divorce.
Are your children in Daycare? ___________________________________________________________________
Do you have childcare expenses? _______________________________________________________________
Do you _____________ or your spouse ______________ have children from a prior marriage
or relationship? Yes or No: _______________ If so, what are their names and dates of
birth? _________________________________________________________________________________________________
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