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Intake Form: For Parents Seeking Legal Representation on Behalf of Their Child

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If your child is facing a juvenile court hearing, he or she needs experienced legal representation to ensure the best possible outcome. To get things started, your child’s attorney will need some basic information about you and your child. Be prepared to share the following information at your first meeting with your child’s lawyer. If you are married, both parents can complete the relevant portions of the same form. If you are not married, or if the other parent is not involved, complete just those portions that apply to you.

Intake Form:  For Parents Seeking Legal Representation on Behalf of Their Child

INFORMATION ABOUT THE CHILD

 

Child’s Name  ____________________________________________

 

Child’s Date of Birth  ______________________________________

 

Child’s Social Security Number         _____________________________

 

Child’s Address          __________________________________________

__________________________________________

__________________________________________

____________________________________ County

 

With whom does your child reside?  __________________________

 

Does your child attend school?  Yes  _____  No  _____

Name of school  _______________________________

 

Does your child have a job?  Yes  _____  No  _____

Name and address of child's employer  ______________________________________________

______________________________________________________________________________

 

Is your child currently in the custody of juvenile authorities?  Yes  _____  No  _____

 

Describe the circumstances that led you to seek legal representation on behalf of your child. 

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List the names of any other persons who may have first-hand knowledge of these events, and the best way to contact them.  ________________________________________________________

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Do you consider the charges that have been raised against your child to be true?

Yes  _____  No  _____

 

Why or why not?  _______________________________________________________________

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Does your child consider the charges that have been raised against him or her to be true? 

Yes  _____  No  _____

 

Why or why not?  _______________________________________________________________

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Has your child previously been charged with an offense?  Yes  _____  No  _____

 

If yes, explain:  _________________________________________________________________

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What was the outcome?  _________________________________________________________

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Does your child have a history of mental illness?  Yes  _____  No  _____ 

 

If yes, explain:  _________________________________________________________________

______________________________________________________________________________

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Does your child have a history of alcohol or drug abuse?  Yes  _____ No  _____

 

If yes, explain:  _________________________________________________________________

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INFORMATION ABOUT THE PARENTS

 

 

MOTHER                                                                   FATHER

 

Name  ________________________________         ____________________________________

 

Date of Birth  __________________________         ____________________________________

 

Address, Including County

_______________________________          ___________________________________

_______________________________          ___________________________________

_______________________________          ___________________________________

 

Home Telephone Number       ____________________        ____________________

 

Work Telephone Number        ____________________        ____________________

Facsimile Number                   ____________________        ____________________

 

E-mail Address                       ____________________        ____________________

 

Best Way/Time to Reach        ____________________        ____________________

 

Employer                                 ____________________        ____________________

 

Position                                   ____________________        ____________________

 

Employer’s Address

_______________________________          ____________________________________

_______________________________          ____________________________________

_______________________________          ____________________________________

 

Are you currently married to each other?  Yes  _____  No  _____

 

Have you ever been married to each other?  Yes  _____  No  _____

 

Other Children

 

 

Name                           Date of Birth   Residing with               Child of Mother,

Whom?                        Father, or Both?

_______________      _________      _______________      ______________

 

_______________      _________      _______________      ______________

 

_______________      _________      _______________      ______________

 

_______________      _________      _______________      ______________

 

_______________      _________      _______________      ______________

 

Other Important Information 

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Questions to Ask My Attorney

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Next Steps
Contact a qualified family law attorney to make sure
your rights are protected.
(e.g., Chicago, IL or 60611)

Help Me Find a Do-It-Yourself Solution