Form 10-501A. Abuse and neglect party information sheet.

Abuse and Neglect Cases – Information Sheet (File with Petition or Amended Petition) Type or print responses. Required in all abuse and neglect cases. ________________________________________________________________________________ THIS SECTION FOR OFFICIAL USE ONLY NOTE TO COURT CLERK: DOCKET EVENT CODE 9509, CRT: Abuse & Neglect Party Information Sheet. Scan document, but will not become part of the official record. Case number: _______ Assigned judge: _______ ______________________________________________________________________ Children’s Court Attorney’s Name: __________________________________________ Person Completing Form: _________________________________________________ Phone Number: _______________________ E-mail: __________________________ New petition ________ Amended petition (enter new info only) ________ Enter as much of the following information as possible: Minor Child 1 Name (F, M, L) Type of current placement* Date of placement Date of Birth Special Conditions† Respondent’s Relation to Minor Child** Respondent 1 Respondent 2 Respondent 3 Minor Child 2 Name (F, M, L) Type of current placement* Date of placement Date of Birth Special Conditions† Respondent’s Relation to Minor Child** Respondent 1 Respondent 2 Respondent 3 Minor Child 3 Name (F, M, L) Type of current placement* Date of placement Date of Birth Special Conditions† Respondent’s Relation to Minor Child** Respondent 1 Respondent 2 Respondent 3 Add information for additional children as necessary. * Type of placement: relative foster care; non-relative foster care; treatment foster care; residential treatment center; mental health facility/non-residential treatment center; juvenile justice facility † Special Conditions: Indian Child Welfare Act (ICWA); Americans with Disabilities Act (ADA) ** Relation to Minor Child: Parent, custodian, guardian, other Respondent 1 Name (F, M, L) Other Name (aka) Address Address Date of Birth Social Security Number Special Conditions† Respondent 2 Name (F, M, L) Other Name (aka) Address Address Date of Birth Social Security Number Special Conditions† Respondent 3 Name (F, M, L) Other Name (aka) Address Address Date of Birth Social Security Number Special Conditions† Add information for additional Respondents as necessary. † Special Conditions: Indian Child Welfare Act (ICWA); Americans with Disabilities Act (ADA)