STATE OF INDIANA IN THE ___________________________ COURT
COUNTY OF ___________________ CAUSE NO. _______________________________
IN RE THE GUARDIANSHIP OF:
________________________
Minor Child
CHILD IN NEED OF SERVICES DISCLOSURE FORM
Comes now, ____________________________________________________________,
and respectfully files a CHINS Disclosure Form. Pursuant to IC 29-3-2-7, this CHINS
Disclosure Form hereby discloses to the Court, under seal, that:
1. A petition for guardianship of the child(ren) has been filed by
____________________________________________________________________ in this case.
2. The parties to this guardianship proceeding are:
______________________________________________________________________________
______________________________________________________________________________
3. I have knowledge that:
☐ A party to these guardianship proceedings in this case has been determined to
be a perpetrator of a substantial report of child abuse or neglect. The name of the
party is: _______________________________________________________;
☐ The child(ren) named in the petition for guardianship in this case has/have
been the subject of a substantiated report of child abuse or neglect;
☐ The child(ren) named in the petition for guardianship in this case has/have
been determined to be a child(ren) in need of services under IC 31-34;
☐ The child(ren) named in the petition for guardianship in this case has/have
been involved in an informal adjustment under IC 31-34-8
4. I/we understand my/our duty under IC 29-3-2-7 to continue to keep the Court
informed, in writing, of any changes to this information.
5. I/we understand that if the information is not given to the Court, a hearing on the
petition regarding guardianship may be delayed until the information is provided to the Court.
6. I/we understand that the Court reviewing the petition to establish guardianship of
the child(ren) may request information from the Department of Child Services regarding the
guardianship petition or proceedings described in IC 29-3-2-7.
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