Juvenile Dependency Filing Information Form
Case Information
Case Number
Filing Date
Court Location
Child Information
Child's Name
Date of Birth
Gender
Female
Male
Other
Race/Ethnicity
Language Spoken
Parent/Guardian Information
Parent/Guardian Name
Relationship to Child
Contact Phone
Parent/Guardian Address
Reason for Dependency Filing
Description/Allegations
Agency/Worker Information
Worker Name
Agency Name
Contact Phone
Email