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2. Parent 1
4. First Name
5. Last Name
6. Date of Birth
   Date of Birth
7. Age
   -- Select One --123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105
9. Email Address
11. Home Address
12. City
13. State
14. Zip Code
16. Do you have a different mailing address?*

    1. Yes
    2. No
18. Mailing Address*
19. City*
20. State*
21. Zip Code*
23. Cell Phone
24. Home Phone
26. Occupation
27. Employer
29. Previous addresses (last 5 years):

    Type each address on a separate line.

33. Parent 2
35. First Name
36. Last Name
37. Date of Birth
    Date of Birth
38. Age
    -- Select One --123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105
40. Email Address
42. Home Address
43. City
44. State
45. Zip Code
47. Do you have a different mailing address?*

    1. Yes
    2. No
49. Mailing Address*
50. City*
51. State*
52. Zip Code*
54. Phone Number
55. Home Number
57. Occupation
58. Employer
60. Previous addresses (last 5 years):

    Type each address on a separate line.

64. Children
66. Child's Name
67. Date of Birth
    Date of Birth
68. School
70. Child's Name
71. Date of Birth
    Date of Birth
72. School
74. Child's Name
75. Date of Birth
    Date of Birth
76. School
78. Child's Name
79. Date of Birth
    Date of Birth
80. School
82. Child's Name
83. Date of Birth
    Date of Birth
84. School
86. Do you have more than 5 children?*

    1. Yes
    2. No
87. List all additional children.*

    Please include the child's name, date of birth, & school.

    Each child should be listed on a separate line.

91. Family Members Currently Living with Child
93. Name
94. Relationship to Child
95. Time Known Child
97. Name
98. Relationship to Child
99. Time Known Child
101. Name
102. Relationship to Child
103. Time Known Child
105. Name
106. Relationship to Child
107. Time Known Child
109. Name
110. Relationship to Child
111. Time Known Child
113. Are there more than 5 family members living with the child?*

     1. Yes
     2. No
114. List all additional family members.*

     Please include the name, relationship to child, & time known child.

118. Non- Family Members Living with Child
120. Name
121. Relationship to Child
122. Time Known Child
124. Name
125. Relationship to Child
126. Time Known Child
128. Name
129. Relationship to Child
130. Time Known Child
132. Name
133. Relationship to Child
134. Time Known Child
136. Name
137. Relationship to Child
138. Time Known Child
140. Are there more than 5 non-family members living with the child?*

     1. Yes
     2. No
141. List all additional non-family members.*

     Please include the name, relationship to child, & time known child.

145. Alcohol & Substance Abuse
147. Are there any protective orders/restraining orders in effect that prevent you from having contact with another person or another person having contact with you?*

     1. Yes
     2. No
149. Case Number*
151. Person(s) Restrained:*
153. Person(s) Protected:*
155. Does either parent or their spouses/significant others have a drug and/or alcohol problem?*

     1. Yes
     2. No
156. If "yes," please explain:*
158. Have you ever had a problem with, or been treated for, abuse of alcohol, prescription drugs, or street drugs? If so, describe the circumstances and treatment (include dates, names, and contact information for treatment providers).
160. Have you, or are you, currently using nonprescription drugs? Please explain:
164. Mental Health Problems
166. Does either parent or their spouses/significant others have any serious emotional or psychological problems which affect their ability to parent?*

     1. Yes
     2. No
167. If "yes," please describe:*
169. Has this parent sought treatment or taken any medication for their problems?*

     1. Yes
     2. No
170. If "yes," please describe:*
174. Criminal History
176. Has either parent ever been convicted of a crime?*

     1. Yes
     2. No
177. If "yes," please explain:*
179. Has a police or sheriff's report ever been filed against either parent or their spouses/significant others?*

     1. Yes
     2. No
180. Who reported?*
181. What was reported?*
183. List any arrests and/or charges made against you in the State of Washington (or any other state) and describe how the charges were resolved (ex: jail, Probation, etc.).
185. Are there any outstanding warrants for arrest for either you or the other parent?*

     1. Yes
     2. No
186. If "yes," who?*
187. Explain the circumstances:*
189. Has either parent or their spouses/significant others been involved in any incidents of domestic violence?*

     1. Yes
     2. No
190. If "yes," explain:*
194. Are you currently married?*

     1. Yes
     2. No
195. If "yes," provide your spouse's name:*
196. If "yes," provide your date of marriage:*
     If "yes," provide your date of marriage:
198. How many times have you been married?*
     -- Select One --012345
200. Name of Spouse*
201. Date of Marriage*
     Date of Marriage
202. Date of Divorce
     Date of Divorce
203. Number of Children*
     -- Select One --012345
205. Age of Children*

     List all children's ages.

     One child per line.

206. Custodial Parent*
208. Name of Spouse*
209. Date of Marriage*
     Date of Marriage
210. Date of Divorce
     Date of Divorce
211. Number of Children*
     -- Select One --012345
213. Age of Children*

     List all children's ages.

     One child per line.

214. Custodial Parent*
216. Name of Spouse*
217. Date of Marriage*
     Date of Marriage
218. Date of Divorce
     Date of Divorce
219. Number of Children*
     -- Select One --012345
221. Age of Children*

     List all children's ages.

     One child per line.

222. Custodial Parent*
224. Name of Spouse*
225. Date of Marriage*
     Date of Marriage
226. Date of Divorce
     Date of Divorce
227. Number of Children*
     -- Select One --012345
229. Age of Children*

     List all children's ages.

     One child per line.

230. Custodial Parent*
232. Do you have a significant other residing with you at this time?*

     1. Yes
     2. No
233. If "yes," does this person have a criminal history?*

     1. Yes
     2. No
234. If "yes," please describe:*
238. Children's Performance & Child Care
240. Describe each child's performance in school over the last three years. Include social skills and academic standing.
242. List the name(s) of the school(s) your children have attended over the last three years and describe the reason for the change in school, if applicable.
244. What is the current childcare schedule?
246. Who transports the child to school and/or daycare?
250. Placement Status
252. Is the current parenting plan:

     1. Court Ordered
     2. Voluntary
253. Please describe the arrangement:
255. Describe what you would like the parenting plan to be like.
257. Do you want to change placement of the child?*

     1. Yes
     2. No
258. Why?
262. References
264. list the names and phone numbers of three independent references (not family or friends) you believe the Court Investigator should contact.
266. Name
267. Phone Number
269. Name
270. Phone Number
272. Name
273. Phone Number
277. Sworn Declaration
279. I swear or affirm under penalty of perjury under the laws of the State of Washington that all of the information above is true.
281. Type your full name here to e-sign.
282. Todays Date
     Todays Date
Leave This Blank:


284. 1. Receive an email copy of this form.
285. Email address

     This field is not part of the form submission.

286. Submit Submit and Print

* indicates a required field