Orange — De Facto Parent Request

Source: https://www.occourts.org/system/files/shc-pb-10.pdf

SUPERIOR COURT OF CALIFORNIA Self-Help Services COUNTY OF ORANGE www.occourts.org/self-help

DE FACTO PARENT REQUEST

SELF-HELP FORM PACKET

SHC-PB-10 (Rev. 08/05/2021)

Self-Help Services can review your completed forms before you file them with the Court. To request review of your completed forms:

1. Complete the attached forms in black ink.
2. Scan your completed forms and save as a single PDF file.
3. Go to www.occourts.org/self-help (click the blue button labeled Click Here to Contact Self-Help Services), attach the PDF, and complete the online request form. Make sure to select PROBATE as the case type on the form.

www.occourts.org/self-help

WHAT IS A “DE FACTO PARENT?”

A “De Facto Parent” means a person who has been found by the court to have assumed, on a day to day basis, the role of parent, fulfilling both the child’s physical and psychological needs for care and affection, and who has assumed that role for a substantial period. (Rule 5.502(10).

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JV-295 De Facto Parent Request Clerk stamps date here when form is filed.

The address of any licensed foster family home must remain confidential unless the judge or the foster parent authorizes release of the address. Court clerks should not send this page to the parties without a court order or authorization of the foster parent. (Welf. & Inst. Code, § 308(a).)

1 My/Our name(s):0 Fill in court name and street address: My/Our address: Superior Court of California, County of

City: State: Zip:
My/Our phone #:

2 I am/We are asking that I/we be appointed de facto parent(s) of0 Court fills in case number when form is filed. (Child’s name): Case Number:

Date:-- --- ,___►----- Type or print your name Signature of person requesting de facto parent status

Date:-- --- ,___►----- Type or print your name Signature of person requesting de facto parent status

Date:-- --- ,___►----- Type or print attorney’s name Signature of attorney (if applicable)

Attorney’s address:
City: State: Zip:
Attorney’s phone #:

NOTICE

If you are not the child, child’s parent, or child’s legal guardian, you may have a right to challenge a decision by the juvenile court, but only in very limited circumstances. You may need a court order granting you access to records in the juvenile case file. For more information, please see Information on Requesting Access to Records for Persons With a Limited Right to Appeal (form JV-291-INFO ). You can get form JV-291-INFO at any courthouse or county law library or online at www.courts.ca.gov/forms.

Judicial Council of California, www.courts.ca.gov Rev. September 1, 2020, Mandatory Form De Facto Parent Request JV-295, Page 1 of 1 Cal. Rules of Court, rule 5.534(a) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form

Clerk stamps below when form is filed. "i JV-296 De Facto Parent Statement

1 My/Our name(s):0

child’s name:
Girl02 The□ Boy □

3 Child’s date of birth: Age:0 l _J Relationship to child (grandparent, foster parent, etc.): Court name and street address:

Superior Court of California, County of

4 The child has lived with me from:0 (date) to (date) (date) to (date)

5 I have had responsibility for the day-to-day care of the child0 Case Number: from: (date) to (date) I I (date) to (date)

6 Information the judge should know about my relationship with0 the child. (This part must be completed).

a. Amount of time I spend with the child (daily, weekly, etc.): d. I □ have □ have not attended
court hearings about the child.

e. I □ have □ have not sent a written
report to the court about the child.
b. Activities I do with the child:

c. Kinds of information I have about the child that others may not have (medical, educational, behavioral, etc.):

7 I declare under penalty of perjury under the laws of the State of California that the information on this form is0 true and correct to my knowledge. This means if I lie on this form, I am committing a crime.

Date: ► _____ _
Type or print your name Signature of person requesting de facto parent status

Date: ►
Type or print your name Signature of person requesting de facto parent status

Judicial Council of California‚ www.courtinfo.ca.gov JV-296, Page 1 of 1Revised January 1, 2007, Mandatory Form De Facto Parent Statement Cal. Rules of Court‚ rule 5.534(e)

JV-290-INFO INSTRUCTION SHEET FOR CAREGIVER INFORMATION FORM Background

1. What is the "Caregiver Information Form"? The Caregiver Information Form, also called form JV-290, is intended to provide an easily accessible way for foster parents, relative caregivers, preadoptive parents, nonrelative extended family members, legal guardians, community care facilities, and foster family agencies (or any other individual or agency currently caring for a foster child) to provide information about the child to the court.

2. When does it need to be filled out and filed? The Caregiver Information Form is an optional form. If you choose to use it, fill it out and file it with the court along with eight copies, at least five days before the hearing, or mail it to the court for filing at least seven days before the hearing. Follow the instructions below. Do not wait until the day of the court hearing to file the form.

3. Current foster parents, relative caregivers, preadoptive parents, nonrelative extended family members, legal guardians, and other individuals caring for a child: You may fill out this form even if a staff person from the child's foster family agency or community care facility is also filling it out. You may write a letter to the court, instead of using the form. Either way, follow the procedures described on the next page about making copies, filing, and attending the hearing. Be aware that the form or letter will be provided to parties and attorneys. If you are a confidential foster parent, provide information to the child's social worker rather than filing the form or letter with the court.

4. Foster family agencies or community care facilities: You may complete this form and use it as the mandatory report required by Welfare and Institutions Code section 366.21. It is recommended that each agency or facility develop a policy about who is responsible for filling out and filing the form or report on behalf of each child.

5. What should I be thinking about as I fill out the form? Use the form to provide factual information about the child, such as behavior you have observed and information about the child's needs. Avoid including opinions or information not related to the child. The goal is to provide information to the court that helps the judge make informed decisions about the child. How to Fill Out Form JV-290

6. Complete the caption. These are the boxes at the top of the page. • Court name, street address, and mailing address. Write the name of the county where the court is located and the street and mailing addresses of the court. If you do not know the name and address of the court, look on the notice of the court hearing you received in the mail or go to www.courtinfo.ca.gov/courts/find.htm to find the local court in your county. For branch name, write "Juvenile." • Child's Name. Write the child's first and last names. • Hearing Date and Time. Write the hearing date and time. Ask the social worker if you do not have this information. • Case Number. This number is on the notice of the court hearing you received in the mail. If you do not have the number, ask the child's social worker or attorney for the number. If the case involves brothers and sisters (siblings), there may be more than one case number. Be sure to use a separate form and the correct number for each child.

7. Complete information about the child and about yourself or your agency. • Item 1. Fill in the child's first and last names, date of birth, and age. • Item 2. Foster parents, relative caregivers, and other individuals caring for children should complete item 2. Include your name, what type of caregiver you are, and how many years and/or months the child has lived in your home. Skip item 3. If you are a confidential foster parent, provide information to the child's social worker rather than filing this form with the court. • Item 3. Foster family agencies, community care facilities, and staff at any other group-care setting should skip Item 2 and complete item 3. Indicate the facility name, address, telephone number, the type of facility, how long the child has been with your agency, and how long he or she has been in the current placement. Then write your name (the person completing form) and your title. If it is not clear from your title, explain in what capacity you work with the child. Indicate how many hours each week you spend with the child. Finally, check the box to indicate whether you are filling out the form based on your own observations and recommendations or on those of a group or team. If applicable, specify the members of the group or team.

Form Approved for Optional Use Welfare and Institutions Code, §§ 366.21; 16010(f)(3); Judicial Council of California INSTRUCTION SHEET FOR Cal. Rules of Court, rule 5.534(m) JV-290-INFO [New October 1, 2007] CAREGIVER INFORMATION FORM www.courtinfo.ca.gov

JV-290-INFO 3. Complete items 4–10 about the child. For each question, check the box to indicate whether there is new information since the last hearing. Briefly write new information in the appropriate section of the form. Do not describe anything you have not personally observed. • Item 4. Provide information on the child's medical, dental, and general physical and emotional health (e.g., doctor visits, hospitalizations, and medications; descriptions of physical or emotional development).

• Item 5. Provide information on the child's status at school, if applicable (e.g., child's grade level; public or
nonpublic school; how the child is doing in school; outcomes of testing or school conferences).
• Item 6. Indicate whether the child is a special education student and, if so, the date of the most recent
Individualized Education Plan (IEP).

• Item 7. Provide information on how the child is adjusting to your home/facility (e.g., child's social skills and
behavior at home; how the child is interacting with other family members; how the child expresses feelings and
needs; the child's eating and sleeping patterns).

• Item 8. Provide information on how the child is getting along with others (e.g., peer relationships, relationships
with teachers and other adults outside of your family).

• Item 9. Provide information on the child's special interests and activities (e.g., participation in sports or music
lessons; how often the child participates; any talents, interests, or hobbies).

• Item 10. Provide any additional information that you believe the court should know about the child (e.g.,
behavioral information; services the child is receiving; your recommendations for additional services that are
needed; visitation information, such as dates of visits with parents or siblings).

4. Recommendation for Disposition (Outcome). If you are a community care facility or foster family agency, you must include your recommendation for disposition if the JV-290 form is being used as your report required under Welfare and Institutions Code section 366.21(d). Foster parents and other individual caregivers may include their recommendation for disposition (outcome) if they choose.

5. Add any attachments. Check the box in item 12 to add additional pages. You may attach information from the child's teacher, doctor, or other service providers and a photograph of the child.

6. Sign and date the form. On the bottom of page 2, write the date, type or print your name, and sign your name.

   What to Do With the Form After You Have Filled It Out

7. Make copies. Caregivers should make eight or more copies of the completed JV-290 form and any attachments.

8. If you choose to file the form in person. At least five calendar days before the hearing date, bring the original

   form and the recommended eight copies to the court clerk's office at the courthouse where the hearing will be held. Ask the clerk to file the form for you. Keep one copy of the date-stamped form for yourself. The clerk is responsible for providing the form to all parties and completing and filing the proof of service form.

9. If you choose to file the form by mail. At least seven calendar days before the hearing date, mail the original form

and all but one of the copies to the court clerk's office at the courthouse where the hearing will be held. Put two stamps on the envelope. Include a note indicating "For filing and service" and including the case number. The clerk is responsible for providing the form to all parties and completing and filing the proof of service form.

4. Confirm the hearing time, date, and place. If you plan to attend the hearing, call the social worker to confirm the hearing date, time, and courtroom.

   What to Do on the Hearing Day

5. Bring extra copies of the form. If you decide to attend the hearing, it is suggested that you make additional copies of the form and any attachments in order to provide copies to anyone at the hearing who did not receive them.

6. Comments in court. If you choose to attend the hearing, any comments you make should be short, factual, and based on your own observations. You may raise your hand to let the judge know you would like to speak, or let the courtroom clerk or deputy/bailiff know before the hearing.

JV-290-INFO [New October 1, 2007] INSTRUCTION SHEET FOR CAREGIVER INFORMATION FORM Page 2 of 2

JV-290 SUPERIOR COURT OF CALIFORNIA, COUNTY OF FOR COURT USE ONLY STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD'S NAME:

HEARING DATE AND TIME:

CASE NUMBER:

CAREGIVER INFORMATION FORM

To the current caregiver, preadoptive parent, community care facility, or foster family agency caring for the child: You may submit written information to the court, and you may attend review and permanency hearings. You may use this optional form to provide written information to the court. Please type or print clearly in ink and submit the original and eight copies of the form to the court clerk's office at least five calendar days (or seven calendar days, if filing by mail) before the hearing. Be aware that other individuals involved in the case have access to this information. See form JV-290-INFO for instructions on how to complete this form and file it with the court.

1. a. Child's name: b. Child's date of birth: c. Child's age:

2. Caregiver Information (Answer only if you are a caregiver, skip #3.): a. Name of caregiver: b. Type of caregiver: D Foster parent D Relative D Legal guardian D Preadoptive parent D Nonrelative extended family member D Other (specify): c. The child has been living in my home for (specify): years months.

3. Agency or Facility Information (Answer only if you are an agency or facility, skip #2.): a. Name of agency or facility: b. Address: c. Telephone number: d. Type of facility: D Foster family agency D Community care agency D Other (specify): e. The child has been placed with our agency/facility for (specify): years months and in the current home for (specify): years months. f. Name of person completing form: Title: g. Hours per week the person completing this form spends with the child (specify): hours/week. h. The information on this form consists of (1) D the observations and recommendations of the person filling out this form. (2) D the observations and recommendations of a group or team made up of the following individuals (specify):

4. Current Status of Child's Medical, Dental, and General Physical and Emotional Health a. D There is no new or additional information since the last court hearing. b. D There is new or additional information since the last court hearing, as follows (do not include the names of doctors):

5. Current Status of Child's Education a. D There is no new or additional information since the last court hearing. b. D There is new or additional information since the last court hearing, as follows (do not include the names of schools):

Form Approved for Optional Use CAREGIVER INFORMATION FORM Welfare and Institutions Code, §§ 366.21(c), (d); Judicial Council of California Cal. Rules of Court, rule 5.534(k) JV-290 [Rev. September 1, 2020] www.courts.ca.gov

JV-290 CHILD'S NAME: CASE NUMBER:

6. Child's Special Education Status a. D The child is a special education student. Date of last Individualized Education Plan (IEP): b. D The child is not a special education student. c. D I do not know the child's special education status.

7. Current Status of Child's Adjustment to Living Arrangement a. D There is no new or additional information since the last court hearing. b. D There is new or additional information since the last court hearing, as follows:

8. Current Status of Child's Social Skills and Peer Relationships a. D There is no new or additional information since the last court hearing. b. D There is new or additional information since the last court hearing, as follows:

9. Current Status of Child's Special Interests and Activities a. D There is no new or additional information since the last court hearing. b. D There is new or additional information since the last court hearing, as follows:

10. Other Helpful Information a. D There is no new or additional information since the last court hearing. b. D There is new or additional information since the last court hearing, as follows:

11. Recommendation for Disposition (Outcome) a. D I have no recommendation for disposition (outcome). b. D I am recommending the following disposition (outcome):

12. D If you need more space to respond to any section on this form, please check this box and attach additional pages. Number of pages attached:

    NOTICE

If you are not the child, child's parent, or child's legal guardian, you may have a right to challenge a decision by the juvenile court, but only in very limited circumstances. You may need a court order granting you access to records in the juvenile case file. For more information, please see Information on Requesting Access to Records for Persons With a Limited Right to Appeal (form JV-291- INFO). You can get form JV-291-INFO at any courthouse or county law library or online at www.courts.ca.gov/forms.

Date: ► (TYPE OR PRINT NAME) (SIGNATURE OF CAREGIVER OR FACILITY/AGENCY STAFF PERSON WHO HAS COMPLETED THIS FORM)

JV-290 [Rev. September 1, 2020] CAREGIVER INFORMATION FORM Page 2 of 2

For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form

Clerk stamps date here when form is filed. JV-297 De Facto Parent Order

COURT WILL FILL OUT SECTION BELOW

The judge, after reading and reviewing the De Facto Parent Request and the De Facto Parent Statement filed by (Name): (Name): Court name and street address: Superior Court of California, County of asking to be appointed the de facto parent(s) of (Child’s name): orders:

1. □ The request for de facto parent status is granted. Case Number:

2. □ The request for de facto parent status is denied.

3. □ The judge orders a hearing on the request for de facto parent status.

   The hearing will take place on at a.m./p.m. in Department: of the Superior Court located at

The court □ does □ does not appoint a lawyer to represent the de facto parent.

The lawyer’s name is: (print name)

Date: Judge (or Judicial Officer)

This is a Court Order.

Judicial Council of California, www.courts.ca.gov JV-297, Page 1 of 1Revised September 1, 2019, Mandatory Form De Facto Parent Order Cal. Rules of Court, rules 5.534(a) and 5.502(10) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form