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Custody Questionnaire

The document is a questionnaire for parents undergoing a child custody and parenting time evaluation. It requests detailed information about the parents, children, and their relationships, as well as proposals for custody arrangements and parenting time. The questionnaire also addresses the children's needs, parenting styles, and any relevant history or ongoing issues.

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4 views10 pages

Custody Questionnaire

The document is a questionnaire for parents undergoing a child custody and parenting time evaluation. It requests detailed information about the parents, children, and their relationships, as well as proposals for custody arrangements and parenting time. The questionnaire also addresses the children's needs, parenting styles, and any relevant history or ongoing issues.

Uploaded by

snzafft
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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612-206-3729

CHILD CUSTODY/PARENTING TIME EVAULATION


PARENT’S QUESTIONNAIRE

Name: _____________________________________________________________
Address: _______________________________________
City: ________________ State: __________ Zip________
Phone:_______________________
e-mail:_______________________
Social Security No._________________

Children’s Names
____________________Birthday______Social Security No._______________
____________________Birthday______ Social Security No._______________
____________________Birthday______ Social Security No._______________

Other Parent’s Contact Information:


Name: _____________________________________________________________
Address: _______________________________________
City: ________________ State: __________ Zip________
Phone:_______________________
e-mail:_______________________
Social Security No. if known______________________

Opposing Counsel Name and Contact Information if any:


Name: _____________________________________________________________
Address: _______________________________________
City: ________________ State: __________ Zip________
Phone:_______________________
e-mail:_______________________

1) What are you requesting for physical custody (Sole or Joint)?

- How would that proposal benefit the children?


2) What are you proposing for legal custody (Sole or Joint)?

- How would that proposal benefit the children?

3) What is the present parenting time schedule (direct contact, phone or other) and
how has it changed over time?

4) What do you propose for the other party’s parenting time/involvement with the
child/ren? Please include exchange times and locations.
5) What is your proposal for recognizing/scheduling holidays in the future? Please
include the dates and times. Please specify which days are of significance to you
and provide an account of the child/ren’s experience celebrating holidays in the
past.

6) List the advantage of your overall proposal for the child/ren:

- Relationship with each parent/party

- Relationship with siblings

- Relationship with extended family members

- Relationship with friends

- Participation in school/community activities

7) List any possible disadvantages for the child/ren in your proposed plan:

- How would you deal with these?


8) What are the childcare tasks for which each party has assumed responsibility
throughout the child(ren)’s lives?

9) What has been each party’s responsibilities/involvement in the child(ren)’s lives?

- Education:

- Religious affiliation/value development:

- Medical Care:

- Daily activities:

- Daycare arrangements/communication/transportation:
10) Describe your child(ren)’s daycare history:

Provider: Dates: Hours Per Week:

11) Describe the child(ren)’s personality and behavior, including any changes you
have noted..

12) Describe each party’s parenting stylye, including methods of discipline.

13) Describe your relationship/interaction with the child(ren).


14) Describe the child(ren)’s relationship/interaction with each of the other adults in
your current/proposed residence.

15) Describe the child(ren)’s relationship/interaction with each other (if more than
one child).

16) List those outside your household who are significantly involved in the
child(ren)’s lives (relatives, step/half siblings, significant others, etc.):

- Describe the child(ren)’s relationship with each of these.

17) Describe the child(ren)’s adjustment to the current childcare/school arrangement,


including grades and relationships with staff and peers.
18) Describe the child(ren)’s friends in the current/proposed neighborhood, including
any activities in which they are involved.

19) List your present and past residences, and length of time at each location:

Address: Dates:

20) Describe your employment.

Employer: Date: Hours Per Week:

21) What is your proposal for chidcare/school for the child(ren)?

- How long have they already been involved in this?


22) List all members of your current/proposed household.

- How long have you lived together?

23) Have the child(ren) lived in your proposed houseshold?

- For how long?

- Describe their adjustment to it.

24) Describe the chid(ren)’s emotional/medical/special physical health needs.

- How does each party meet these?


25) List/describe all services provided to you and/or the other party by mental health
professionals, including individual, couples, family therapy; chemical dependency
assessment/treatment; recommendations/medications/diagnoses:

- Current

- Past

26) List/describe any ongoing medical conditions for which professional care is
provided for you and/or the other party:

27) List your criminal history and any knowledge you have regarding the other
party’s criminal history, including motor vehicle violations:
28) Describe your strength and weaknesses as a parent.

29) Describe the other party’s strengths and weaknesses as a parent, including any
specific concerns you have about his/her parenting skills/practices.

30) What are the goals/values you hope to instill in the child(ren)?

- How do you plan to do this?

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