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Family Court Services (FCS) Data Sheet (Confidential) FCS-002 - California
| Family Court Services (FCS) Data Sheet (Confidential) Form. This is a California form and can be used in Family San Diego Local County . |
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO FAMILY COURT SERVICES (FCS) DATA SHEET (CONFIDENTIAL) Case Name _________________________ PLEASE COMPLETE ALL THREE PAGES Have you previously been to Family Court Services? Yes No Case No. __________________________ FCS Date __________________________ Next Court Date ____________________ IF YOU ARE BEING PROTECTED BY A RESTRAINING ORDER OR IF YOU ALLEGE DOMESTIC VIOLENCE, YOU MAY BE SEEN SEPARATELY. Are you requesting a separate session? Yes No If you want to be seen separately, please advise the Family Court Services Clerk when you check in. SUPPORT PERSON: If you are being protected by a restraining order, a support person may accompany you during your FCS session. The support person must first sign a Family Court Services Domestic Violence Support Person Agreement (SDSC Form #FCS-038). Please advise the Family Court Services Clerk of your support person when you check in. Are you requesting that your address and telephone number remain confidential? CHECK ONE Father Mother Grandparent Yes No Other: specify relationship _______________________________________ AKA OR MAIDEN NAME Apt. #. City State Zip Code FULL LEGAL NAME ADDRESS Number and Street HOME TEL. NO. ___________ WORK TEL. NO. ____________ WORK SCHEDULE _____________________________ SOCIAL SECURITY NUMBER BIRTH DATE / / PLACE OF BIRTH Yes No DRIVER LICENSE NUMBER ___________________ STATE_________________ CURRENTLY VALID ATTORNEY _________________________________________________________ TELEPHONE NO. _____________ ADDRESS Number and Street Apt. #. City State Zip Code CHILD(REN)'S ATTORNEY (if any) _________________________________________TELEPHONE NO. _____________ ADDRESS Number and Street Apt. #. City State Zip Code PARENTS: Date of Marriage _____________ or If dissolution filed, when? Date Began Living Together_____________ Date of Separation ____________ ___________________ NAME OF MINOR CHILD(REN) First 1. 2. 3. 4. SDSC FCS-002 (Rev. 10/11) Middle Last Date of Birth Place of Birth Parent with whom residing FAMILY COURT SERVICES (FCS) DATA SHEET (CONFIDENTIAL) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com CASE NAME CASE NUMBER MEDICAL AND DENTAL INFORMATION Child(ren) Doctor's Name ADDRESS Number and Street Apt. #. City State Zip Code Telephone No. Please list medical/dental information to be discussed at FCS: EDUCATION Child 1. 2. 3. 4. COUNSELING Is Child(ren) Father Mother in Counseling? Yes No Counselor for: Counselor's Name Address Telephone No. When did counseling begin? (Such as special classes, team activities, transportation to Name of School Teacher/Counselor Grade Counselor for: Counselor's Name Address Telephone No. When did counseling begin? CHILD(REN)'S ACTIVITIES AND OTHER SPECIAL NEEDS and from these activities) 1. Are there allegations of verbal intimidation or threats? 2. Has there been physical violence between the parents? If yes, how long ago? 0 - 6 mos. Yes 6 mos. - 1 yr. No Yes Yes No No 1 yr. or more 3. Has law enforcement been involved? Please provide details:____________________________________________________________________________________ 4. Have there been allegations of abuse against the child(ren)? a. If yes, when: b. Who made the allegations? c. Who was the alleged abuser? d. Has Child Protective Services (CPS) been involved? e. CPS worker's name and telephone number Yes No Yes No SDSC FCS-002 (Rev. 10/11) FAMILY COURT SERVICES (FCS) DATA SHEET (CONFIDENTIAL) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com CASE NAME CASE NUMBER FAMILY COURT SERVICES (FCS) DATA SHEET Please complete the following questions. 1. Which parent filed the current court action? 2. What is the action regarding? 3. Is there a court order regarding custody and visitation now? a. If yes, briefly summarize: Yes No b. When was it issued? 4. If there is no court order or a different schedule is being practiced, please summarize your current parenting schedule. 5. What parenting schedule would you like to have? Date: Signature of Party Filling Out This Form NO ATTACHMENTS PLEASE SDSC FCS-002 (Rev. 10/11) FAMILY COURT SERVICES (FCS) DATA SHEET (CONFIDENTIAL) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com
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