GAL INTAKE QUESTIONNAIRE

Please complete this form for each child involved in the proceeding.

Your Information

Your First name

Your Last Name

Your Email

Your Date of Birth

Number of Children. Note you will complete a new form for each child.

Child Information

Child's Full Legal Name

Address

Date of Birth

Place of Birth

Sex of child

Current School

Current Grade

School Email

School Phone Number

After school activities/schedule:

Grades from last report card

Please upload a copy of the most recent report card

I will keep the Guardian ad Litem updated with my child's grades during the pendency of this case.

Yes

Health issues/concerns/special needs?

Mental health diagnosis/treatment?

Name, phone number and address of any person treating the child for medical/occupational/mental health/other service not already included above:

Is there another child involved in this case?

Yes