Stanislaus — Relative Information

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/jv-285-relative-information-packet.pdf

JV-285 Relative Information Clerk stamps date here when form is filed.

As the relative of a child who has been removed from the home, you may
give written information to the court about the child at any time on this form
or in a letter. After filling out this form, give it to the clerk of the court.

Please note that other people involved in the case, including the parents, will
see your answers on this form. If you prefer to keep your contact information
private, fill out Confidential Information ( ) and do not write your
address or telephone number below.

1 Your name: Social worker fills in court name and street address.
Your address: Superior Court of California, County of
Stanislaus

Your telephone number: 2215 Blue Gum Avenue, Room 15
Modesto, CA 95358
Check here if contact information is confidential and form JV-287 is Juvenile Division
attached.

Social worker fills in child's name and date of birth.
2 Your relation to the child: maternal paternal
Child's Name:
grandparent brother/sister aunt/uncle cousin
family friend Date of Birth:
tribal extended family member
Social worker fills in case number.
other (specify):
Case Number:
3 Child’s name:

4 I would like to talk to the judge at the next court hearing.
Please fill in as much of the following information as you know. If you need more space to respond to any section on this
form, attach additional pages as needed and check the box at item 12.

5 Information about the child’s medical, dental, and general physical health:

6 Information about the child’s emotional and behavioral health:

7 Information about the child’s education:

8 Other information that might be helpful to the court:

Judicial Council of California, www.courts.ca.gov Rev. September 1, 2020, Optional Form Relative Information JV-285, Page 1 of 2 Welfare & Institutions Code, § 309 Cal. Rules of Court, rules 5.534(b) and 5.637

form JV-287

Case Number: Child’s name:

Below are some things you might do to help the child. You can pick some or none of the things listed below. It is up to the
social worker and the court whether you will be asked to do these things.
9 I want to
telephone the child. take the child to visits with parents.
write letters to the child. take the child to medical appointments.
take the child on outings. supervise the child during visits with brothers and sisters.
take the child to/from school. watch the child after school.
take the child to visits with brothers or sisters. have the child live with me.
take the child to therapy. other (describe):
take the child to family gatherings.
help the social worker make a case plan for the
child.

You can also help the parents. For example, you might help with transportation, housing, visits, or child care. It is up to
the social worker and the court whether you will be asked to do these things.

10 I want to help the father mother
(Describe):

11 Other relatives who might be able to help the child:
a. Name: Relationship to child:
Contact information:
or I want to keep the contact information confidential and ask that the child’s social worker get this
information from me.
b. Name: Relationship to child:
Contact information:
or I want to keep the contact information confidential and ask that the child’s social worker get this
information from me.
c. Name: Relationship to child:
Contact information:
or I want to keep the contact information confidential and ask that the child’s social worker get this
information from me.

12 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 ). You can get form at any courthouse or county law library
or online at

Date:

Type or print your name Sign your name

Rev. September 1, 2020 Relative Information JV-285, Page 2 of 2

JV-291-INFOJV-291-INFOwww.courts.ca.gov/forms.

JV-287 Confidential Information Clerk stamps date here when form is filed.

This form is used to keep contact information confidential. It may be used along with any Judicial Council juvenile form, including Request to Change Court Order (form JV-180), Application and Affidavit for Restraining Order (form JV-245), Relative Information (form JV-285), Caregiver Information Form (form JV-290), De Facto Parent Request (form JV-295), and Position on Release of Information to Medical Board of California (form JV-228).

You do not need to fill out this entire form. Write only the information that you know. Fill in court name and street address: Superior Court of California, County of This information must be kept under seal in the court file. Only the court, the Stanislaus agency, and the child's attorney may look at this information. 2215 Blue Gum Avenue, Room 15 Modesto, CA 95358 1 Your name: Juvenile Division Your telephone number: Your address: Fill in child’s name and date of birth: Child’s Name:

Date of Birth:

Court fills in case number when form is filed.

2 Child’s name: Case Number: Child’s telephone number, if known:

Child’s address, if known:

3 If known: Child’s Indian custodian, if any (name each): Custodian’s telephone number:

Custodian’s address:

4 If known: Child’s caregiver (name each): Caregiver’s telephone number:

Caregiver’s address:

Judicial Council of California, www.courts.ca.gov Rev. September 1, 2020, Optional Form Confidential Information JV-287, Page 1 of 1 California Rules of Court, rule 5.534