Fill and Sign the Guardian Report Colorado Form

 District Court  Denver Probate Court ____________________________________ County, Colorado Court Address: IN THE MATTER OF: Minor COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division: Courtroom: GUARDIAN’S REPORT (MINOR) If you, as Guardian of the Minor, are ordered by the Court to make certain reports, you must follow the directions of the Court as to the timing and content of those reports. You must report the condition of the minor and account for money and other assets in your possession as Guardian or subject to your control as Guardian for the minor (§15-14-207(2)(e), C.R.S.) If you are ordered by the Court to report periodically, but no other directions as to the content of the reports are given, this form of report is intended to facilitate the preparation of the Guardian’s Report. GUARDIAN’S INFORMATION: Guardian’s Name: __________________________________________________________ Home Address: __________________________________________________________ Including P.O. Box: __________________________________________________________ Phone Number: (_______)__________________________________________________ Work Address: __________________________________________________________ Including P.O. Box: __________________________________________________________ Phone Number: (_______)__________________________________________________ MINOR’S INFORMATION: Minor’s Name: __________________________________________________________ Current Address: __________________________________________________________ Phone Number: __________________________________________________________ Date of Birth: (______ _)_________________________________________________  Please check this box if any of the above information has changed since the last Guardian’s Report. 1. What school, preschool or day care is the child attending? Please provide the full name ,, address and phone number. If the child is not attending, please explain. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2. Please give a brief description of how the child is doing in this school, pre-school or day care. CPC 32-GRM R7/04 GUARDIAN’S REPORT (Minor) Page 1 of 4 This form conforms in substance to CPC 32-GRM. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. What extracurricular activities is the child involved in? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 4. What is the name, address and phone number of the child’s treating physician? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 5. When was the child’s last physical exam? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 6. Are there any medical problems concerning the child? If so, please explain. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 7. Are the child’s immunizations up to date? If not, please explain. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 8. Have there been any injuries, accidents or behavior problems not previously reported? If so, please explain. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 9. Does the child have medical insurance coverage at this time? Please provide name of insurer and phone number. If not, please explain. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 10. How does the child interact with the other household member(s)? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 11. Is the child in any counseling? If so, please provide the name, address and phone number for the counselor. CPC 32-GRM R7/04 GUARDIAN’S REPORT (Minor) Page 2 of 4 This form conforms in substance to CPC 32-GRM. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 12. Does the child have any contact with the biological parents? If so, how often and how long are these visits? When was the last visit? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 13. What is the biological father’s last known address and phone number? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 14. What is the biological mother’s last known address and phone number? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 15. Does the child have any contact with other family members on the mother’s side or father’s side? If so, please describe. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 16. Do you or the child receive any financial support from the parents? If so, please describe. If there is a child support order, please provide the name of the court, case number, date of most recent order and status of payments. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 17. Are you or the child receiving any benefits from the Department of Human Services, Social Security or any other sources? If so, please describe source and amount. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 18. Who is the current Guardian ad Litem (GAL), if any, and when was your last contact with this person? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 19. Are there any issues that you feel this court needs to address regarding the child? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 20. Do you feel you need to have a conference with the judge regarding your concerns? CPC 32-GRM R7/04 GUARDIAN’S REPORT (Minor) Page 3 of 4 This form conforms in substance to CPC 32-GRM. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 21. Do you have any comments or concerns that you wish to share with this court? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 22. What are your plans for care during the next year? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 23. Do you recommend that this guardianship continue? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 24. What changes would you make to the guardianship? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Dated: _______________________ ____________________________________ Signature of Guardian CERTIFICATE OF SERVICE I certify that on ____________________ (date), a copy of this Guardian’s Report (Minor) was served on each of the following at the indicated address by:  hand delivery  certified U.S. mail, postage pre-paid  first class U.S. mail, postage pre-paid  registered U.S. mail, postage pre-paid Name and Address ______________________________________ Signature of Person Certifying Service CPC 32-GRM R7/04 GUARDIAN’S REPORT (Minor) Page 4 of 4 This form conforms in substance to CPC 32-GRM.