Madera — Petitioner(s) Screening Form -Guardianship (MAD-FCS-013)

Source: https://www.madera.courts.ca.gov/system/files/forms-and-filings/mad-fcs-013-petitioners-screening-form-rev-04-15-2020.pdf

MADERA COUNTY SUPERIOR COURT PETITIONER (S) SCREENING FORM - GUARDIANSHIP

PETITIONER(S)/NAME:

CASE NUMBER: FCS File No.

COURT DATE: DEPT: TIME:

PETITIONERS RELATIONSHIP TO MINOR:

CHILD/CHILDREN AT ISSUE: DOB DOB DOB

NATURAL PARENTS: Mother DOB

Father DOB

Where is the minor residing at this time? With Petitioner With Parents Other: Mark the box that applies to the allegations in this petition:

Domestic violence Substance abuse Child abuse
Overall neglect Care taker absence Other:

In the following questions, do not reveal the names of the reporting party who contacted

CWS/CPS. That information shall be kept CONFIDENTIAL.

Are you aware of any Child Welfare Service (CPS) complaints made against the parents? Yes No

If so, are you aware of the outcome of such complaints? Yes No

Are you aware of the names of the social workers? Yes No

Were you referred to the Probate Court by a social worker? Yes No
If Yes, what were the reasons given to you for such referral? ____________________________

Were you offered a Temporary voluntary case management plan through CWS to have custodial care of the minor at issue and told to file a Probate Guardianship by a certain date? Yes No If yes, please provide the court with a copy of the plan.

SIGN

Petitioner (s)/Attorney’s Signature Address Phone Number

Form Adopted for Optional Use PETITIONER(S) SCREENING FORM-GUARDIANSHIP Page 1 of 1 Madera Superior Court Local Form MAD-FCS-013 [Rev. 04/15/2020]