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SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE (The Superior Court of California - County of Orange)

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Page 1 of 2
Approved for Optional Use
L-0373 [New September 14, 2009]
PETITION FOR GRANDPARENT VISITATION
Family Code §§ 3102, 3103, 3104
Cal. Rules of Court 5.150, 5.154(b), 5.156, 5.158
ATTORNEY (Name & Address):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name): BAR NO.:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
JUSTICE CENTER:
Lamoreaux – 341 The City Drive, Orange, CA 92868-3205
Central – 700 Civic Center Drive West, Santa Ana, CA 92701
PETITIONER:
RESPONDENT: 
PETITION FOR GRANDPARENT VISITATION
CASE NUMBER:
1. Petitioner’s relationship to minor child(ren) listed below:
grandmother grandfather
my son (name) is the parent of the child(ren).
my daughter (name) is the parent of the child(ren).
Child’s name
Birthdate
Currently living with
(relationship) / in (county)
Other Parent’s Name
2. The parents of the child(ren) (mark all boxes and complete all spaces which apply):
a.
are currently married or have a domestic partnership and living together.
b.
are divorced. A Judgment for Dissolution of Marriage or Domestic Partnership was entered on:
(specify date)
, in County, (state)
Case No.
.
c.
are currently involved in a divorce proceeding in County, Case No. .
d.
are currently married or have a domestic partnership and one of the parents has been absent for more
than one month without the other parent knowing the whereabouts of the absent parent.
e.
have never been married or in a domestic partnership.
f.
are currently living separate and apart on a permanent or indefinite basis.
g.
The mother father of the minor child(ren) is deceased.
h.
The child(ren) is/are not residing with either parent.
i.
The child(ren) has/have been adopted by a stepparent grandparent other (specify relationship
and name):
.
CASE NAME:
CASE NUMBER:
Approved for Optional Use
L-0373 [New September 14, 2009]
PETITION FOR GRANDPARENT VISITATION
Page 2 of 2
Family Code §§ 3102, 3103, 3104
Cal. Rules of Court 5.150, 5.154(b), 5.156, 5.158
3. Describe the relationship between each child and the petitioner(s). Explain the reason why grandparent visitation
is in the best interest of each child:
continued in attached declaration.
4. Describe the duration and frequency of visitation that is being requested:
continued in attached declaration.
5.
A completed declaration under the Uniform Child Custody Jurisdiction and Enforcement Act, form FL-105, is
attached. (Not required if the Petition is filed within an open Family Law Case.)
6. Petitioner(s) requests that the court grant reasonable visitation with the above named child(ren), and such other
relief as the court may deem appropriate, pursuant to Family Code sections 3100, 3102, 3103 and 3104.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
PARENT CONSENT TO PETITIONER’S REQUEST FOR GRANDPARENT VISITATION
Mother Father hereby consents to and joins in this petition for Grandparent Visitation.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF PARENT OF MINOR CHILD(REN))
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE (The Superior Court of California - County of Orange)

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Completed 8 February 2021

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