Child Custody Mediation Intake Form | Pdf Fpdf Docx | California

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Child Custody Mediation Intake Form | Pdf Fpdf Docx | California

Last updated: 5/16/2023

Child Custody Mediation Intake Form

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CHILD CUSTODY MEDIATION INTAKE FORM CONFIDENTIAL. This form is used by the Family Court Services of the Superior Court of California, County of Yolo. It is filled out by a parent or guardian before their scheduled appointment for child custody mediation. The form collects information about the parent/guardian, including their name, contact details, date of birth, address, and employment information. It also requests information about the other party involved and their contact details. The form gathers details about the children involved, including their names, schools, and any other children not living with the parent/guardian. It asks about the family and relationship history, including the nature of the relationship with the other party, dates of marriage and separation, and any existing custody orders. There are sections dedicated to current custody and time share information, requested custody arrangements, and time share preferences. The form inquires about alcohol consumption, drug use, and any involvement with law enforcement or criminal activity. It also addresses domestic violence history and child welfare, asking about reports to child protective services. Additionally, the form asks about counseling or mental health services and requires a declaration regarding allegations of domestic violence. It seeks information on completing the required orientation packet and video, the need for an interpreter, access to Zoom, and how the CCRC Report should be received. The form concludes with a declaration under penalty of perjury and a space for the signature and date of the person completing the form.

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