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CARETAKER'S REPORT TO THE COURT

Child:	Legal Case Number:
Hearing Date:
Completed by:	Relationship:

TOPICS:
1. Child's physical health: (State results of medical and dental appointments)




























2. Child's emotional health: (Appointments with counselor or therapist)


























3. Child's visits with parent(s):






Caretaker's Report to the Court/page 2

Child:

Caretaker:

4. Child's adjustment with peers:














5. Child's adjustment to home:














6. Special problems:
















7. Special hobbies/interest, strengths:
















8. Thoughts on Department's case plan: