Custody Questionnaire
Fill out this form if you are not married to the other parent.
Today's Date
MM
/
DD
/
YYYY
Personal Data
Your Full Name *
Phone number (where we can contact you) *
Address *
Secure email address *
Birthdate *
MM
/
DD
/
YYYY
Driver's License Number and Issuing State
In which month and year did you first move to Clark County, Nevada?
Other Parent's Information
Other Parent's Full Name *
Birthdate *
MM
/
DD
/
YYYY
Phone Number *
Address *
Other parent's Attorney (if any)
Information about children of this relationship
Full Name of Child
Birthdate of Child
MM
/
DD
/
YYYY
Full Name of Second Child
Birthdate of Second Child
MM
/
DD
/
YYYY
If there are additional children of this relationship, put their names and birthdates here.
Do you and the other parent agree on where the children should be for each day of the week? *
Visitation Schedule (as desired)
Children should be with Mom or Dad on these days and times:
What are your biggest issues or concerns regarding custody of the children?
Employer Information
Your Employer's Name/Company
Employer's Address
Your Job Title *
Gross Monthly Income *
This amount should be higher than your take-home pay.
How many years have you worked at this job?
What is your work schedule and how many hours do you work per week?
Other Parent's Employer and Job Title *
Other parent's work schedule and # of hours worked per week:
Other parent's Gross Monthly Income *
Has the other parent been physically abusive to you or to the children?
Clear selection
Have you or the other parent ever been arrested? *
Is there a Temporary Protective Order (TPO) in place?
Clear selection
Has anyone previously filed any legal papers regarding custody?
Clear selection
Have you consulted with another attorney?
Clear selection
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.