6. A Child in Need of Services (CHINS) petition
has been filed regarding this child and is open
closed
has not been filed regarding this child.
7. A program of informal adjustment
has been filed regarding this child and is open
closed
has not been filed regarding this child
8. Petitioner(s):
are aware of another guardian appointed for or acting as the custodian of the minor child
and their name is and their address is:
are not aware of another guardian appointed for or acting as the custodian of the minor child.
9. A protective order:
has been issued for the minor.
has not been issued for the minor.
10. The person or institution (“Caregiver”) having the care and custody of the Minor Child at this time is:
Name
Street Address
City, State, Zip
11. The names and address of relatives most closely related by blood or marriage to the Minor Child are the following (if whereabouts are unknown, so indicate):
Mother:
Name
Age
Address
Father:
Name
Age
Address
Other Relationship:
Name
Age
Address