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

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 __________________________________________

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____________________________________ 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 ______________________________________________

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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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