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The juvenile information sheet neither replaces nor supplements the filing and service of pleadings or other papers as required by law. This form is required for use by the Clerk of the District Court for the purposes of initiating the juvenile docket sheet. This information will not be available to the public and this document will be stored in a separate location from the case file and then destroyed within a reasonable time. A new case will not be accepted without a cover sheet attached. (THIS FORM MUST BE TYPED OR PRINTED LEGIBLY). This form can be found at www.kscourts.org.

JUVENILE INFORMATION SHEET

For Office Use Only

JUVENILE
NATURE OF SUIT (Click or mark in one circle only)
JUVENILE OFFENDER CHILD IN NEED OF CARE Abuse Termination of Parental Rights Neglect Other Dependency/Child Victim Dependent (no fault) Status Offense/Petition

CHILD'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO: SSN: RACE:

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO:

State and Number

DOB:

White

Black

Asian

American Indian/Alaskan Unknown Unknown

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

State and Number

DOB:
Foster Parent(s) Other Parent

Custodian

Pacific Island

Guardian

ETHNICITY: Hispanic SEX: ALIAS NAMES USED:

Non-Hispanic

SEX: ALIAS NAMES USED:

KDR Transaction Number______________________ ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number) (Firm Name, Address, Telephone Number and Supreme Court ID Number)

ATTORNEYS (if known)

OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO:

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO:

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

State and Number

State and Number

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

DOB:

Custodian Foster Parent(s) Guardian Parent Other

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

DOB:

Custodian Foster Parent(s) Guardian Parent Other

PHONE: _____________________SEX: ALIAS NAMES USED:

PHONE: ___________________SEX: ALIAS NAMES USED:

ATTORNEYS

(Firm Name, Address, Telephone Number and Supreme Court ID Number) (Firm Name, Address, Telephone Number and Supreme Court ID Number)

ATTORNEYS (if known)

____________________________________________ The requirement that Social Security numbers be included on juvenile cases is not mandatory. The number is used for purposes of identification and may be disclosed as permitted by law. This form is not considered to be a public record. 07-11-2006

ADDITIONAL JUVENILE PARTY INFORMATION
OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO: SSN: RELATIONSHIP TO CHILD:
Grandparent(s)
State and Number

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO:

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

DOB:

Custodian Foster Parent(s) Guardian Parent Other

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

State and Number

DOB:

Custodian Foster Parent(s) Guardian Parent Other

PHONE: _____________________SEX: ALIAS NAMES USED:

PHONE: ___________________SEX: ALIAS NAMES USED:

ATTORNEYS

(Firm Name, Address, Telephone Number and Supreme Court ID Number) (Firm Name, Address, Telephone Number and Supreme Court ID Number)

ATTORNEYS (if known)

____________________________________________ OTHER PARTY'S INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)

OTHER PARTY'S INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)

NAME: ADDRESS: DL OR STATE ID NO:
State and Number

NAME: ADDRESS: DL OR STATE ID NO:
State and Number

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

DOB:

Custodian Foster Parent(s) Guardian Parent Other

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

DOB:

Custodian Foster Parent(s) Guardian Parent Other

PHONE: _____________________SEX: ALIAS NAMES USED:

PHONE: ___________________SEX: ALIAS NAMES USED:

ATTORNEYS

(Firm Name, Address, Telephone Number and Supreme Court ID Number) (Firm Name, Address, Telephone Number and Supreme Court ID Number)

ATTORNEYS (if known)

____________________________________________

OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO: SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

OTHER PARTY'S INFORMATION NAME: ADDRESS: DL OR STATE ID NO:

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

State and Number

DOB:

Custodian Foster Parent(s) Guardian Parent Other

SSN: RELATIONSHIP TO CHILD:
Grandparent(s)

State and Number

DOB:

Custodian Foster Parent(s) Guardian Parent Other

PHONE: _____________________SEX: ALIAS NAMES USED:

PHONE: ___________________SEX: ALIAS NAMES USED:

ATTORNEYS

(Firm Name, Address, Telephone Number and Supreme Court ID Number) (Firm Name, Address, Telephone Number and Supreme Court ID Number)

ATTORNEYS (if known)

____________________________________________ The requirement that Social Security numbers be included on juvenile cases is not mandatory. The number is used for purposes of identification and may be disclosed as permitted by law. This form is not considered to be a public record. 07-11-06