COUNTY SUPERIOR COURT
and Phone Number of parent/guardian for whom you are completing the
Superior Court Cause No
Family Court Services No.
you answer each question below, please keep in mind that it is the
responsibility of the Court to safeguard the welfare and future
development of the child(ren) in this family. You can help the Court in
meeting this responsibility by being objective. The evaluator may
contact you to discuss your statement with you. This questionnaire is to
be completed immediately and returned to: Regional Justice Center,
Family Court Services, 401 North Fourth Avenue, Suite 1D, Kent,
Your phone _ ___ ___
Your relationship to the parent/guardian above (friend, relative, mother, father, employer, etc.) _former employer___
long have you known this parent/guardian?
often do you see him/her: 0
last seen 9/98
How long have you known the child(ren) in this case: 4.5 years about (since birth) to present
often do you see them: 0
last seen 9/98
you know the other parent? Yes
If yes, for how long: approx. 6 years Date last seen 9/98
you have been in the home of the parent/guardian for whom you are a
home including housekeeping standards, who prepares meals, etc.:
Both parents prepare meals, bathe child, change and feed their son. The house is in a orderly clean manner. Child is loved, clean, and well cared for. Both parents communicate in sign language w/ their son.
CARE OF CHILD(REN):
how this parent/guardian treats the child(ren) (cleanliness, clothing,
is well supervised and disciplined well. I have never seen any type of abuse by either parent towards or
the quality of the relationship between the parent/guardian and the
Loving, for this child will thrive well w/ both parents in his life. They both love him very much.
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