Kern — Guardianship questionnaire

Source: https://www.kern.courts.ca.gov/system/files/forms-and-filings/guardianship-questionnaire-rev-62026_0.pdf

Family Court ServicesSUPERIOR COURT OF 1215 Truxtun Avenue,CALIFORNIA 3rd Floor COUNTY OF KERN Bakersfield, California 93301 Patricia Arredondo, LCSW Telephone: (661) 610-6700 Manager of Family Court Services Fax: (661) 688-7412 Mediation & Investigation Email: FCS@kern.courts.ca.gov

Guardianship Questionnaire

Instructions:

MAKE SURE TO READ AND FOLLOW ALL THE INSTRUCTIONS IN ORDER TO AVOID ANY DELAYS IN YOUR CASE.

You are receiving this questionnaire because you are a party to a relative guardianship case. This questionnaire is a vital piece of the guardianship petition. The court has the authority to order an investigation as part of the case proceedings. Therefore, it is important the entire packet is completed and returned along with your petition to the Probate Court window.

This questionnaire is confidential and will not become part of the public record. The personal identifying information will be kept in a confidential location at all times.

All persons who are 18 or older who live in the home are required to undergo a background check. Therefore, they are required to complete the “Background Information” page of this packet. Make additional copies as necessary.

No recording or recording devices of any kind are allowed during any contact. We do not consent to being recorded and non-consensual recordings are a violation of Penal Code § 632. If we discover that we are being recorded directly or indirectly, the violation will be referred to the Sheriff’s Department for investigation.

Make sure all pages which require a signature have been signed.

Make photocopies or use extra paper as necessary.

Attach any extra papers to the end of the packet.

The court has a self-help center that can help you complete this packet. The Self Help Center office is at 1215 Truxtun Ave., 1st floor, Bakersfield, California. You may contact them at (661) 610-6518 or by email: WMSelfHelp@kern.courts.ca.gov Please visit https://www.kern.courts.ca.gov/self-help

Subject Child(ren) Information Case Number: Make additional copies as necessary – Attach additional copies to back of packet Child

Legal name of child (as on birth certificate):

Name child is known by: Date of birth:

Place of birth: Current age: Gender:

Name of child’s doctor: Telephone:

Current health problems:

Date of last examination: Is child in counseling?

Counselor’s name: Telephone:

Name of school: Address:

Grade: Teacher’s name:

Are there special educational needs? Yes No If yes, please explain:

Is the child subject to any legal custody orders? Yes No If yes, please explain:

Child

Legal name of child (as on birth certificate):

Name child is known by: Date of birth:

Place of birth: Current age: Gender:

Name of child’s doctor: Telephone:

Current health problems:

Date of last examination: Is child in counseling?

Counselor’s name: Telephone:

Name of school: Address:

Grade: Teacher’s name:

Are there special educational needs? Yes No If yes, please explain:

Is the child subject to any legal custody orders? Yes No If yes, please explain:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 1 of 12 Event Code 8524 (Rev. 8/2025)

Relationship Information

Probate Code 1513(g) For the purpose of this section, a “relative” means a person who is a spouse, parent,
stepparent, brother, sister, brother, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew,
first cousin, or any person denoted by the prefix “grand” or “great,” or the spouse of any of these persons, even
after the marriage has been terminated by death or dissolution.

How are you and the child(ren) related?
☐Stepparent Grandparent Brother/Sister Stepbrother/sister ☐ ☐ ☐
Aunt/Uncle 1st Cousin Niece/nephew ☐Half-brother/sister ☐ ☐
or Great relative Spouse/former spouse to one of these persons ☐Grand ☐
None of these options applies ☐

The child and I are related by Biological Legal adoption ☐ ☐
Legal marriage of parents or biological/legal relative No legal or biological relation ☐ ☐

Mother’s side Father’s side Both parents None ☐ ☐ ☐ ☐

Explain how you and each of the child(ren) are related:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Do you have supporting documents? Yes No ☐ ☐
What documents do you have?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 2 of 12 Event Code 8524 (Rev. 8/2025)

ICWA: Indian Heritage & Tribal Information

1. Are the child(ren) or their parents members of an American Indian tribe or an Alaskan Native
community?
Yes No If the answer is no, go to #3 ☐ ☐
In what tribe(s)/band(s)/Alaska Native village(s) do they have membership?
____________________________________________________________________________
Do they have an enrollment card or number or an Enrollment number/Indian Identification
Card/CDIB/Indian Preference card/Indian Identification card?
Yes No I don’t know ☐ ☐ ☐
2. Is anyone in the child’s family a member of a tribe? Yes No I don’t know ☐ ☐ ☐
If the answer is yes, answer the following questions:

What is the person’s full name/maiden name?________________________
What is their relationship to the child? __________________________________
Does that person have an Enrollment number/Indian Identification Card/CDIB/Indian Preference
card/Indian Identification card? Yes No I don’t know ☐ ☐ ☐

3. Are you aware of any Native American, Alaskan Native, or American Indian ancestry in any of the
children’s biological extended family?
Yes No I don’t know ☐ ☐ ☐
If the answer is yes, answer the following questions:

From what tribe(s)/band(s)/Alaska Native villages do they have ancestry?
__________________________________________________________________________________
__________________________________________________________________________________

How did you come to know this information regarding the parents and the child(ren)’s ancestry?
___________________________________________________________________________

Is there anyone in yours or the parent’s family who may have more information about the child(ren)’s
Native American, Alaskan Native, or American Indian heritage? Yes No ☐ ☐

What is the person’s full name and contact information?
___________________________________________________________________________
What is their relationship to the child(ren)?
___________________________________________________________________________

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 3 of 12 Event Code 8524 (Rev. 8/2025)

Guardian’s Information If there are multiple petitioners/guardians, each one must complete and sign pages 3 thru 8 Make additional copies as necessary – Attach additional copies to back of packet

Relationship to subject child(ren):

Current physical location of child(ren):

How long have you known the child(ren):

Briefly explain the circumstances that led to this proceeding and why the child(ren) should be in your care:

Legal name: Other names used:

Any other names you use or have used, including nicknames:

Social Security #: License or ID #: State:

Date of birth: Place of Birth:

Race: Gender:

Height: Eye Color: Hair Color:

Language(s) Spoken:

Address: City: Zip:

Mailing address if different:

Best phone number to call: Message phone #:

Your email address:

** Please Notify Family Court Services Of Any Changes To Your Address Or Phone Numbers **

Education:
Highest grade completed: Where:

List any additional training or education:

Employment: Employer Name: Job Title:

Employer’s Address:

May we contact you at work? Yes No

Employer’s phone #: Length of employment:

Current working schedule:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 4 of 12 Event Code 8524 (Rev. 8/2025)

Military Service: Branch: Date and type of Discharge:

Marital History: Number of previous marriages:

Date and place of current marriage:

Name of current spouse: _____________________________________________________________

List all of your Children: (Attach additional sheets if necessary)
Name Age Other parent’s name With whom do they live

Health:
Current health problems? Yes No If yes, please explain:

Mental Health History:
Have you ever been diagnosed with a mental health condition? Yes No If yes, give brief explanation:

Have you ever been hospitalized voluntarily or involuntarily for a mental health condition? Yes No

Have you ever been prescribed any medications for a mental health condition? Yes No

Substance Abuse History:
Do you currently use or have you ever used illegal drugs? Yes No If yes, please explain:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 5 of 12 Event Code 8524 (Rev. 8/2025)

Do you drink alcohol? Yes No

Have you ever had an alcohol problem? Yes No If yes, please explain:

Child Protective Services History:
Have you ever been investigated by Child Protective Services? Yes No

Living Arrangements:

Number of people living in your current residence: Number of bedrooms:

Length of time at your current residence: years months Are you: Renting Buying Own

Accommodations for the child(ren):

Do you plan to remain in this location or are you looking for other accommodations? Explain:

All others living in the home (Adults and Children):
Name Age Relationship to the subject child(ren)

Financial:
Source if Income:
Monthly Income: Additional income:

Do you receive cash aid for the child(ren)? Yes No If no, will you be applying for cash aid? Yes No

Do the child(ren) have MediCal coverage? Yes No If no, will you be applying for coverage? Yes No

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 6 of 12 Event Code 8524 (Rev. 8/2025)

Additional Information: Are you currently or have you previously been appointed a guardian? Yes No

If yes, provide name of child(ren), the date, the County where it was established and the case number:

Have you or anyone in your household ever been the subject of any type of a restraining order? Yes No

If yes, give brief explanation:

References:
Name Relationship to you:

Mailing Address:

Telephone Number: Email Address:

Name Relationship to you:

Mailing Address:

Telephone Number: Email Address:

Name Relationship to you:

Mailing Address:

Telephone Number: Email Address:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 7 of 12 Event Code 8524 (Rev. 8/2025)

Legal/Birth Mother: Make additional copies as necessary – Attach additional copies to back of packet

Full Name: Mother of:

Age: Date of birth or approximate date of birth:

Other names she uses or has used, including nicknames:

Residence:

Telephone: Other contact number:

Does the mother visit the child(ren): Explain:

Has the mother provided any financial support for the child(ren)? Yes No

If yes, how much? Date of payments:

Is mother in agreement with the guardianship? Explain:

Legal/Birth Father: Make additional copies as necessary – Attach additional copies to back of packet

Full Name: Father of:

Age: Date of birth or approximate date of birth:

Other names he uses or has used, including nicknames:

Residence:

Telephone: Other contact number:

Does the father visit the child(ren): Explain:

Has the father provided any financial support for the child(ren)? Yes No

If yes, how much? Date of payments:

Is father in agreement with the guardianship? Explain:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 8 of 12 Event Code 8524 (Rev. 8/2025)

Informed Consent for Guardianship Evaluation Evaluation Procedures- A Family Court Services’ Investigator will be gathering information from many sources, including but not limited to law enforcement, Child Protective Services, schools, day care, and our own observation of you, the child(ren) and others involved in this case. The Release of Information form will provide us with access to medical, school, legal, and other information related to the issues under investigation. Evidence- Any evidence you provide to the investigator will be destroyed upon completion of the investigation and filing of the report. It is your responsibility to file any evidence with the court in accordance with the rules of court if you want it to be considered by the court. Confidentiality- Quite simply, within the process, there is no confidentiality. We may share information one party tells us with the other party or ask you questions about what we hear from a party, child(ren), or a collateral source. We will inform the child(ren) their statements may not be confidential, though we may inform you, your attorneys, and the court if we believe it is in the best interest of the child(ren) to protect that confidentiality. **Please note that California state law requires reporting to the appropriate agencies in cases where there is reasonable suspicion of child abuse, elder abuse, stated intention to injure another person and/or imminent danger of harming yourself. Recommendations- A written report will be prepared and filed with the Court. Please be aware, it will always be based the investigators analysis of all of the evaluation data and what they believe to be in the best interest of the child(ren). Confidentiality of the Report- Pursuant to California Probate Code §1513(d) all reports authorized by this section are confidential and shall only be made available to persons who have been served in the proceedings or their attorneys. No recording or recording devices of any kind are allowed during any contact. We do not consent to being recorded and non-consensual recordings are a violation of Penal Code § 632. If we discover that we are being recorded directly or indirectly, the violation will be referred to the Sheriff’s Department for investigation. Complaints- If you have a concern or a complaint regarding the Investigator assigned to your case, you may contact Patricia Arredondo, Manager of Family Court Services, at 1215 Truxtun Avenue, 3rd Floor, Bakersfield, CA 93301, (661) 610-6700. Consent- I have read and understand this Consent for Guardianship Evaluation, and expressly consent to allow the Kern County Superior Court, and its agents and employees, to conduct an evaluation. I hereby declare under penalty of perjury that all information I have submitted is true and correct. Date: ___________________________ Print Name: _______________________________________

Signature:

Case Number:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 9 of 12 Event Code 8524 (Rev. 8/2025)

SUPERIOR COURT OF Family Court Services CALIFORNIA 1215 Truxtun Avenue, 3rd Floor COUNTY OF KERN Bakersfield, California 93301 Telephone: (661) 610-6700 Patricia Arredondo, LCSW Fax: (661) 688-7412 Manager of Family Court Services Email: FCS@kern.courts.ca.gov Mediation & Investigation

RELEASE OF INFORMATION

I, , as
(Print name) (Relationship to child)

specifically authorize any public agency, private person, employer or past employer, medical
doctor, psychologist, treating therapist, hospital, public or private school districts (including
teacher) possessing information about me or the minor child(ren), including psychiatric
information, confidential or otherwise, to release same (including copies) to the Kern County
Superior Court through its duly appointed Court Investigator, such information to be used as
the Court may deem fit and proper. I understand that Family Court Services will conduct a
criminal and Child Protective Services’ background check on me in the course of this
investigation.

A copy of this release shall be as valid as the original.
This release shall remain in effect for one year from this date unless otherwise revoked.

Date: Print Name:

Signature:

Case Number:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 10 of 12 Event Code 8524 (Rev. 8/2025)

Background Information

This page must be completed by all other persons, 18 years or older, who live in the home. NOT THE PETITIONER(S)

Make additional copies if necessary Case Number:

Your full legal name:

Any other names you have used, including maiden name:

Your relationship to the child(ren):

Your Street Address:

City: Zip Code:

Best phone number to call: Message phone #:

Mailing Address if different:

Social Security #: Date of Birth:

Gender: Race: Height: Eye Color:

Hair Color: Driver’s License or ID #: State:

Place of Birth:

Place of Employment:

I have a:(circle) Social Worker Probation Officer Parole Officer None

Their name and telephone number is:

I understand that a Kern County Superior Court Investigator will perform a criminal background check on me as part of the guardianship investigation. I understand that the purpose of the investigation is to make recommendations to the court regarding whether a guardianship is necessary and in the best interest of the subject child(ren).

I certify under penalty of perjury that the information I have provided is true and correct.

Date: Signature:

Printed Name:

Adopted for Mandatory Use KRN SUP CRT PB 8524 (Eff. 01/01/20) GUARDIANSHIP QUESTIONNAIRE Page 11 of 12 Event Code 8524 (Rev. 8/2025)