SUIT FOR MODIFICATION OF CUSTODY CHILD CUSTODY QUESTIONNAIRE

THE INFORMATION CONTAINED IN THIS DOCUMENT IS CONFIDENTIAL AND SUBJECT TO THE FAMILY ATTORNEY CLIENT AND WORK PRODUCT PRIVILEGE

Suit for modification of custody:

The following form is designed to help us to better litigate your custody case. Some of these questions may be asked of you on the witness stand, and your answers on the witness stand may be subject to cross- examination by opposing counsel. It is very important that you answer this questionnaire truthfully regarding yourself and the child(ren)’s other parent, as your attorney will rely upon the truthfulness of your answers in preparing your case.

You should answer all questions relevant to your case. If you believe that a question does not apply to your case, please indicate by marking the question “N/A.” If the answer to any question requires more space than has been provided on the form, please complete your answer on a separate sheet.

This form is designed for parents or non-parents involved in a custody litigation to modify a prior custody order.

WARNING:

• DO NOT discuss the litigation with your
• DO NOT show this form to your children or request their assistance in completing
• DO NOT make inquiries to your children related to this
• DO NOT speak negatively or disparagingly about the other parent (or his or her relatives or friends) to your children or in front of your

Such behavior is frowned upon by the Court and may negatively affect the outcome of your custody case. It is NOT healthy for your children to be involved in your custody litigation. They do not “deserve” nor are they “entitled” nor do they “need” to know what is going on in your custody litigation. It is not healthy for your children to hear negative or disparaging remarks about either of their parents (or that parent’s relatives or friends).

SUIT FOR MODIFICATION OF CUSTODY. BACKGROUND INFORMATION

Name of Client:                                                Case No.                                         Your relationship to the children:                                                             

In regard to the court order that awards you conservatorship and access or visitation with the children, please summarize your court-ordered relationship to the children:

Name of Other Parent or Person Seeking Custody:                                                                                                                                                                           In regard to the court order that awards this person conservatorship and access or visitation with the children, please summarize this person’s court-ordered relationship to the children:

For the children who are the subject of this custody litigation, please list:

1. Name: Age:              Date of Birth:                                
2. Name: Age:              Date of Birth:                                
3. Name: Age:              Date of Birth:                                
4. Name: Age:              Date of Birth:                                

Where do the above-named child(ren) primarily reside?                                                                                                                                                                          Is the primary residence of the child(ren) listed above in compliance with a current court order? If not, indicate the current circumstances related to the child(ren)’s current primary residence that deviates from current court orders (for example,

the parents have agreed to the new residence, etc.)

For Your Other Children who are NOT the subject of this custody litigation, please list:

1. Name: Age:              Date of Birth:                                
2. Name: Age:              Date of Birth:                                

Where do your other children who are not a part of this custody litigation reside? Please give details regarding any currently existing orders or information agreements regarding the child(ren)’s custody, visitation and current living arrangements, including how long these arrangements have been in effect:

For the Other Party’s Other Children who are NOT the subject of this custody litigation, please list:

1. Name: Age:              Date of Birth:                                
2. Name: Age:              Date of Birth:                                

Where do the other parent’s children from outside the relationship currently reside? Please give details regarding any currently existing orders or information agreements regarding the child(ren)’s custody, visitation, and current living arrangements, including how long these arrangements have been in effect:

EDUCATION

The following information relates only to the children who are the subject of this custody litigation, not your children or your other party’s children who are not the subject of this custody litigation.

For each child, please provide the following information. A separate section has been provided for each child, so do not attempt to include all of the information in the first section.

Name of Child:                                                                 Grade:                              School:                                           Dates attended:                                                          School Address:                                                                                   .

Name(s) of Teacher(s), Counselor(s), & Principal(s):

1.                                                                                 Position:                                         
2.                                                                                 Position:                                         
3.                                                                                 Position:                                         
4.                                                                                 Position:                                         

If any of the aforementioned teacher(s), counselor(s), or principal(s) might have knowledge of information significant to your custody case, other than the standard information a school would normally maintain (such as attendance records and grades), please state the name of the person with the information and give a brief description of the information. An example of this information might be having witnessed behavior by a parent or child relevant to this case:                                                                                                                                                                                                                                       .

Name of Child:                                                              Grade:                               School:                                                        Dates attended:                                              School Address:                                                                                                                    

Name(s) of Teacher(s), Counselor(s), & Principal(s):

1.                                                                                 Position:                                         
2.                                                                                 Position:                                         
3.                                                                                 Position:                                         
4.                                                                                 Position:                                         

If any of the aforementioned teacher(s), counselor(s), or principal(s) might have knowledge of information significant to your custody case, other than the standard information a school would normally maintain (such as attendance records and grades), please state the name of the person with the information and give a brief description of the information. An example of this information might be having witnessed behavior by a parent or child relevant to this case:                                                                                                                                                                                                                                       .

Name of Child:                                                               Grade:                               School:                                                        Dates attended                                              School Address:                                                                                                                    

Name(s) of Teacher(s), Counselor(s), & Principal(s):

1.                                                                                 Position:                                         
2.                                                                                 Position:                                         
3.                                                                                 Position:                                         
4.                                                                                 Position:                                         

If any of the aforementioned teacher(s), counselor(s), or principal(s) might have knowledge of information significant to your custody case, other than the standard information a school would normally maintain (such as attendance records and grades), please state the name of the person with the information and give a brief description of the information. An example of this information might be having witnessed behavior by a parent or child relevant to this case:                                                                                                                                                                                                                                       .

Name of Child:                                                               Grade:                               School:                                                        Dates attended:                                              School Address:                                                                                                                    

Name(s) of Teacher(s), Counselor(s), & Principal(s):

1.                                                                                 Position:                                         
2.                                                                                 Position:                                         
3.                                                                                 Position:                                         
4.                                                                                 Position:                                         

SUIT FOR MODIFICATION OF CUSTODY CARE OF THE CHILDREN

If any of the aforementioned teacher(s), counselor(s), or principal(s) might have knowledge of information significant to your custody case, other than the standard information a school would normally maintain (such as attendance records and grades), please state the name of the person with the information and give a brief description of the information. An example of this information might be having witnessed behavior by a parent or child relevant to this case:                                                                                                                                                                                                                                       .

Care

The following information relates to responsibilities for the care of the children. Please describe the degree to which the parties to this custody litigation share these responsibilities, if applicable. We understand that some children are old enough to provide a certain level of care for themselves. If that is the case, please indicate in your answer. Additionally, because this is a custody modification, some of these questions may apply differently depending upon whose possession the children are in. If you are answering a question that relates only to your periods of possession, please indicate the same in your response.

1. Who helps dress the child(ren) in the morning? ☐ Mom           ☐ Dad            ☐ Child(ren)
2. Who bathes and grooms the child(ren)? ☐ Mom           ☐ Dad            ☐ Child(ren)
3. Are any of the child(ren) nursing? ☐ Yes             ☐ No
4. Who takes care of the child(ren) during the day? ☐ Mom           ☐ Dad            ☐ Other
5. If other, please specify who:                                                                                                              
6. If the children are in daycare, after school care, or otherwise cared for by a sitter or person other than a parent, please provide the following information: Name:                                                                                Address: Hours per week spent in such care:                                                                                  
7. Who arranged for the child(ren)’s daycare? ☐ Mom           ☐ Dad
8. Who arranges for playdates with friends? ☐ Mom           ☐ Dad            ☐ Child(ren)
9. Who takes the child(ren) to extracurricular activities? ☐ Mom          ☐ Dad            ☐ Child(ren)
10. What is each parent’s level of participation in the child(ren)’s extracurricular activities? (For an assistant coach, a team parent, or a frequent or sometimes spectator)
11. Who puts the child(ren) to bed at night? ☐ Mom   ☐ Dad  ☐ Child(ren)
12. Who prepares the child(ren)’s meals? ☐ Mom ☐ Dad  ☐ Child(ren)
13. Who arranges for medical and dental care for the child(ren) and takes the child(ren) to the doctor, dentist, or therapist? ☐ Mom    ☐ Dad  ☐ Child(ren)
14. Who takes the child(ren) to school? ☐ Mom    ☐ Dad  ☐ Child(ren)
15. Who picks the child(ren) up from school? ☐ Mom  ☐ Dad   ☐ Child(ren)
16. Who shops for the child(ren)’s clothes? ☐ Mom  ☐ Dad  ☐ Child(ren)
17. Who shops for the child(ren)’s food and hygiene needs? ☐ Mom ☐ Dad            ☐ Child(ren)
18. If your child(ren) play video games (computer or television), who, if anyone, monitors the child(ren)’s video game usage: ☐ Mom           ☐ Dad
19. Please include comments, as applicable, regarding restriction of the level of videos the child(ren) are allowed to purchase and/or play:                                                                                                                                                          .
20. If your child(ren) watch movies, videos, or Tik Toks, who, if anyone, monitors the type of movie the child(ren) are allowed to watch? ☐ Mom  ☐ Dad  ☐ Child(ren)
21. If the child(ren) use the internet for social networking, what social networking sites do they use?
22. Facebook  ☐ Instagram ☐ Twitter  ☐ Snapchat  ☐ TikTok Other:                                                                             .
23. If the child(ren) use the internet for purposes other than social networking, please describe those other purposes:
24. Is the child(ren)’s use of the internet monitored? ☐ Yes  ☐ No
25. If so, by whom and under what circumstances? Are there rules the child(ren) must follow? If so, what are they?
26. If a child has his/her own computer, where is it located? And can he/she access it privately without supervision?
27. Do the child(ren) have their own cellphone? ☐ Yes  ☐ No
28. Is their use of the cell phone monitored or otherwise limited by an rules or regulations? Yes ☐ No
29. Describe the child(ren)’s religious training if any, including the level of parental participation in such training:
30. Who purchases & prepares gifts for the child(ren) to take to other birthday parties? Mom ☐ Dad ☐ Child(ren ☐ 
31. Who arranges the child(ren)’s birthday parties? ☐ Mom    ☐Dad 
32. Who helps the child(ren) with their homework? ☐ Mom  ☐ Dad ☐ Child(ren)
33. Who attends parent-teacher conferences? ☐ Mom ☐ Dad
34. Do either parent, or both, participate in regular daily school activities? (for example, providing assistance for school parties, dances, sports activities, ) ☐ Mom           ☐ Dad   ☐ Both
35. Are the child(ren) more likely to turn to you or the other parent when they have problems? Mom ☐ Dad
36. Do you feel the child(ren) are closer to you or the other parent?  ☐ Mom  ☐ Dad
37. Who cares for the child(ren) when they are ill? ☐ Mom  ☐ Dad    ☐ Both
38. Who cares for the child(ren) when they are on a school holiday? ☐ Mom ☐ Dad Both ☐ Other:
39. Who disciplines the child(ren)? ☐ Mom ☐ Dad  ☐ Both
40. What method of discipline is used?                                                                                                                  
41. Are you and the other parent able to agree on the method of discipline used? Yes ☐ No
42. Has the division of responsibility for childcare changed during the course of the children’s lives? Yes ☐ No
43. If so, please specify how and explain why such responsibilities have changed:                                                                                                                                          
44. If so, please specify the time and distance involved:                                                                                                                                                              
45. What are your working hours?                                                                                                                        
46. What time do you leave home for work?                                                 
47. What time do you return home from work?                                              
48. Do you have flexible working hours? ☐ Yes    ☐ No
49. Does your job require travel? ☐ Yes   ☐ No
50. If so, please specify the anticipated change:                                                                                                                                                                   
51. Is your work schedule likely to change in the future? ☐ Yes   ☐ No
52. What are the other party’s working hours?                                                                                                                        .
53. What time does the other party leave home for work?                                              
54. What time does the other party return home from work?                                          
55. Does the other party have flexible working hours? ☐ Yes    ☐ No
56. Does the other party’s job require travel? ☐ Yes  ☐ No
57. Do the child(ren) have any special or unusual physical/medical needs? ☐ Yes  ☐ No
58. Who has addressed these needs since the date of entry of the last order?  ☐ Mom  ☐ Dad
59. What are your current housing arrangements? (including the size of the residence, number of bedrooms, and who resides with you):                                                                                                                  If you are awarded custody of the child(ren), explain how you will continue to pursue and address these needs:                                                                                    If so, please specify the time and distance involved:                                                                                                                                                                   
    32. If so, please specify the anticipated change:                                                                                                                                                                 
    33. Is the other party’s work schedule likely to change in the future? ☐ Yes     ☐ No
    33. If you are awarded primary custody of the child(ren), what are your plans for the child(ren)’s care? (Ex. daycare, after school program, ):
60. Will your current housing arrangements change at the conclusion of the litigation or do you have plans on changing your current housing arrangements in the near future? ☐ Yes    ☐ No
61. Describe the other party’s current living arrangements:                                                                                                                 
62. If so, please specify details:                                                                                                                                                                   
63. Has your child(ren)’s academic performance changed since the date of entry of the last custody order? ☐Yes ☐ No
64. Has your child(ren)’s attitude or emotional state changed since the date of entry of the last custody order? ☐Yes ☐ No
65. Have your child(ren) voluntarily indicated to you a preference to reside with one party over the other? ☐Yes ☐ No
66. If so, what statements have they made?                                                                                                                                                                   

WARNING: DO NOT ASK YOUR CHILDREN THIS QUESTION OR ELICIT THIS INFORMATION IN ANY MANNER OR FORM. DO NOT ENCOURAGE YOUR CHILDREN TO TALK ABOUT INFORMATION THAT MIGHT BE RESPONSIVE TO THIS QUESTION OR ANY OTHERINFORMATION IN THIS FORM. We are only inquiring as to information that may have been voluntarily conveyed without suggestion or any type of encouragement by you.

QUESTIONS REGARDING THE PARTIES SUIT FOR MODIFICATION OF CUSTODY

Has the other party ever made unwanted negative physical contact with you, or physically abused you? (Example, hitting, shoving, dragging during an argument):                         ☐ Yes             ☐ No

2. If you answered “yes,” please answer the following questions:

– Did you report the abuse to the authorities:  ☐ Yes             ☐ No

– Did the authorities take any action regarding the abuse: ☐ Yes             ☐ No

– Did you tell anyone about the abuse: ☐ Yes             ☐ No

If yes, who did you tell and when did you tell them: ___________________________________

– Is there any remaining evidence of the abuse? (Example: photos, physical injuries/ bruises, broken furniture or walls, etc.)     ☐ Yes             ☐ No

3. Have you ever made unwanted negative physical contact with the other party, or physically abused the other party? (Example: hitting, shoving, dragging during an argument):☐ Yes ☐ No
4. If you answered “yes,” please answer the following questions:

– Did you report the abuse to the authorities? ☐ Yes             ☐ No

– Did the authorities take any action regarding the abuse? ☐ Yes             ☐ No

– Did you tell anyone about the abuse? ☐ Yes             ☐ No

– If yes, who did you tell and when did you tell them:                                                                                       

– Is there any remaining evidence of the abuse? (Example: photos, physical injuries, bruises, broken furniture or walls, etc.) ☐ Yes             ☐ No

5. Do you currently have a paramour?    ☐ Yes             ☐ No
6. If you answered “yes,” please answer the following questions:

– Has your paramour had contact with your child(ren)?   ☐ Yes             ☐ No

If so, explain the nature of and amount of such contact:                                                                                                                                                     

– Have you and your paramour had physical contact in the presence of your child(ren)? (Example, handholding, kissing, etc.)   ☐ Yes             ☐ No

– Has your paramour spent the night with you while you had possession of the children?  ☐ Yes             ☐ No

7. If the other party has a paramour, have your child(ren) ever voluntarily mentioned him/her to you?  ☐ Yes             ☐ No

If so, what statements have they made?                                                                                                                                                             

WARNING: DO NOT ASK YOUR CHILDREN THIS QUESTION OR ELICIT THIS INFORMATION IN ANY MANNER OR FORM. DO NOT ENCOURAGE YOUR CHILDREN TO TALK ABOUT INFORMATION THAT MIGHT BE RESPONSIVE TO THIS QUESTION OR ANY OTHER INFORMATION IN THIS FORM.

We are only inquiring as to information that may have been voluntarily conveyed without suggestion or any type of encouragement by you.

8. Are you currently married?  ☐ Yes             ☐ No

                        – Name of Step-Parent/Spouse:                                                                                                                                                 

– Does the Step-Parent/Spouse have any children from a prior relationship? ☐ Yes     ☐ No

– If so, please list the name, age, date of birth, and residence of each child below:

1. Name:                                                                         Age:              Date of Birth:                            

Residence:                                                                        

2. Name:                                                        Age:                Date of Birth:                            

Residence:                                                                        

Please briefly summarize any current court orders relating to the custody, visitation and support of the children:                                                                                                                                                                                                                        .

10. Is your spouse court-ordered to pay child support? ☐ Yes             ☐ No
11. Is he/she behind in his/her child support obligation? ☐ Yes             ☐ No

If so, please explain:                                                                                              

12. If the other party has a spouse, have your child(ren) ever voluntarily mentioned him or her to you? If so, what statements have they made?  ☐ Yes      ☐ No

WARNING: DO NOT ASK YOUR CHILDREN THIS QUESTION OR ELICIT THIS INFORMATION IN ANY MANNER OR FORM. DO NOT ENCOURAGE YOUR CHILDREN TO TALK ABOUT INFORMATION THAT MIGHT BE RESPONSIVE TO THIS QUESTION OR ANY OTHER INFORMATION IN THIS FORM. We are only inquiring as to information that may have been voluntarily conveyed without suggestion or any type of encouragement by you.

13. Are you and the other party able to communicate with each other regarding your child(ren)?   ☐ Yes       ☐ No

– If you answered “yes,” briefly summarize the subject matter, nature, and regularity of such communications:                                                                                                                                                                             

– If you answered “no,” briefly summarize the communications attempt made, if any, and describe how such communications have failed: ________________________________________________________________

14. Do you believe that you and the other party will be able to successfully communicate regarding your child(ren) after the litigation is concluded? ☐ Yes       ☐ No
15. To what extent do you and the other party share or not share values regarding how the child(ren) should be raised, including discipline, education, religious training, etc.?                                                                                              

16. How well do your children get along with each other?                                                                                              

17. How well do your children get along with their step-siblings and half-siblings?                                                            

18. How well do your children get along with your spouse / the step parent?                                                                        

19. How well do your children get along with the other party’s spouse / other step parent?                                              

20. Do your child(ren) have a close relationship with any of their grandparents?                                                                

21. Do your child(ren) have a close relationship with anyone else that you believe is significant?                                       

22. What are your future goals for your child(ren) and what reasons do you have for those goals?                                                                                          

23. Have you and the other party attempted to work out a settlement of the issues regarding your children? ☐ Yes             ☐ No

If so, please summarize the result:                                                                                                                                                                                        

POTENTIAL WITNESSES SUIT FOR MODIFICATION OF CUSTODY

Who do you think would make good witnesses for you and what do you think the testimony would be? Examples of potential witnesses include teachers, counselors, friends, doctors, daycare providers, clergy, co-workers, employers, and family members.

Name:                                                                             Relationship:                                                 

Address:                                                                                             

Telephone:                                                                                              

Summary of information this witness might testify to:                                                                                 

Do you believe this witness would voluntarily testify?         ☐ Yes             ☐ No

If not, please state why you believe this witness would not voluntarily testify:                                      

Name:                                                                           Relationship:                                             

Address:                                                                                              

Telephone:                                                          

Summary of information this witness might testify to:                                                                              

Do you believe this witness would voluntarily testify?         ☐ Yes             ☐ No

If not, please state why you believe this witness would not voluntarily testify:                                                      

Who do you think will testify against you and what do you think the testimony would be?

1. Name:                                                                                      Relationship:                                                    

Address:                                                                                          

Telephone:                                                                     

Summary of information this witness might testify to:                                                                             

2. Name:                                                                                           Relationship:                                                 

Address:                                                                                          

Telephone:                                                                

Summary of information this witness might testify to:                                                                  

SKELETONS

REMINDER: IT IS IMPERATIVE THAT YOU BE OPEN AND HONEST IN ANSWERING THIS QUESTIONNAIRE, INCLUDING THE FOLLOWING QUESTIONS. ANY DISCUSSION OF THESE TOPICS BETWEEN YOU AND YOUR ATTORNEY (AND YOUR ATTORNEY’S STAFF) WILL BE PROTECTED BY THE ATTORNEY CLIENT PRIVILEGE. FAILURE TO BE COMPLETELY HONEST WITH YOUR ATTORNEY COULD BE DISASTROUS TO YOUR CASE.

IF YOUR ANSWER TO ANY ONE OF THE FOLLOWING QUESTIONS IS YES, PLEASE GIVE DETAILS IN THE SPACE PROVIDED AT THE CONCLUSION OF THIS SET OF QUESTIONS:

HAVE YOU:

1. Been arrested? ☐ Yes   ☐ No                                     
2. Been indicted? ☐ Yes   ☐ No
3. Been no-billed?  ☐ Yes   ☐ No
4. Been convicted? ☐ Yes   ☐ No
5. Been acquitted? ☐ Yes  ☐ No
6. Been put on probation? ☐ Yes  ☐ No
7. Been placed on deferred adjudication? ☐ Yes  ☐ No
8. Been incarcerated?  ☐ Yes  ☐ No
9. Used illegal drugs? ☐ Yes  ☐ No
10. Used marijuana or any other narcotic or hallucinogen at a location where the use is legal? ☐ Yes ☐ No

If so, provide the location, approximate date and drug used: ___________________________________________

___________________________________________________________________________________________

11. Abused prescription drugs? ☐ Yes ☐ No
12. Been hospitalized for drug use? ☐ Yes ☐ No
13. Abused alcohol? ☐ Yes  ☐ No
14. Been hospitalized for alcohol use? ☐ Yes   ☐ No
15. Attempted suicide?  ☐ Yes   ☐ No
16. Been hospitalized for a mental health disorder? ☐ Yes  ☐ No
17. Received mental health treatment of any kind? ☐ Yes  ☐ No
18. Taken prescription medication for your mental health? ☐ Yes  ☐ No
19. During the marriage (or relationship), had a homosexual or bisexual relationship? ☐ Yes  ☐ No
20. During the marriage (or relationship), engaged in unusual sexual practices? ☐ Yes  ☐ No
21. Had a pregnancy outside of marriage?  ☐ Yes  ☐ No
22. Had a sexually transmitted disease? ☐ Yes  ☐ No
23. Failed to timely or completely pay court-ordered child support? ☐ Yes ☐ No  ☐ N/A
24. Denied court-ordered visitation to another person? ☐ Yes  ☐ No  ☐ N/A
25. Executed an affidavit of relinquishment of the parent-child relationship between yourself and a child? ☐ Yes  ☐ No  ☐ N/A

26. Had the parent-child relationship between yourself and a child terminated? ☐ Yes  ☐ No   ☐ N/A

27. Do you drink socially? ☐ Yes  ☐ No 

If so, what do you drink and with what frequency?                                                                                                                              

Comments related to your answers to the above questions:                                                                                                                                

If there are any other matters regarding yourself, your lifestyle and your history that might be perceived as negative by others, please briefly summarize these matters:

HAS YOUR CURRENT SPOUSE (A STEP-PARENT):

1. Been arrested? ☐ Yes ☐ No                                     
2. Been indicted? ☐ Yes ☐ No
3. Been no-billed? ☐ Yes ☐ No
4. Been convicted? ☐ Yes ☐ No
5. Been acquitted? ☐ Yes ☐ No
6. Been put on probation? ☐ Yes ☐ No
7. Been placed on deferred adjudication? ☐ Yes ☐ No
8. Been incarcerated? ☐ Yes ☐ No
9. Used illegal drugs? ☐ Yes ☐ No
10. Used marijuana or any other narcotic or hallucinogen at a location where the use is legal? ☐ Yes ☐ No

If so, provide the location, approximate date and drug used:                                                                                                                                                        

11. Abused prescription drugs?   ☐ Yes ☐ No
12. Been hospitalized for drug use? ☐ Yes  ☐ No
13. Abused alcohol? ☐ Yes ☐ No
14. Been hospitalized for alcohol use? ☐ Yes  ☐ No
15. Attempted suicide?  ☐ Yes☐ No
16. Been hospitalized for a mental health disorder? ☐ Yes  ☐ No
17. Received mental health treatment of any kind? ☐ Yes  ☐ No
18. Taken prescription medication for your mental health? ☐ Yes  ☐ No 
19. During the marriage (or relationship), had a homosexual or bisexual relationship? ☐ Yes  ☐ No
20. During the marriage (or relationship), engaged in unusual sexual practices? ☐ Yes ☐ No
21. Had a pregnancy outside of marriage? ☐ Yes ☐ No
22. Had a sexually transmitted disease? ☐ Yes  ☐ No
23. Failed to timely or completely pay court-ordered child support? ☐ Yes ☐ No ☐ N/A
24. Denied court-ordered visitation to another person? ☐ Yes   ☐ No ☐ N/A
25. Executed an affidavit of relinquishment of the parent-child relationship between themselves and a child? ☐ Yes ☐ No  ☐ N/A

26. Had the parent-child relationship between themselves and a child terminated?  ☐ Yes  ☐ No  ☐ N/A

27. Does your current spouse drink socially? ☐ Yes ☐ No             

If so, what do they drink and with what frequency?                                                                                                                                                         

Comments related to your answers to the above questions:                                                                                                                                              

If there are any other matters regarding your current spouse, their lifestyle and their history that might be perceived as negative by others, please briefly summarize these matters:                                                                                                                                                                                                                                    

HAS THE OTHER PARTY:

1. Been arrested? ☐ Yes ☐ No  ☐ Not sure           
2. Been indicted? ☐ Yes ☐ No  ☐ Not sure
3. Been no-billed? ☐ Yes ☐ No   ☐ Not sure
4. Been convicted? ☐ Yes ☐ No  ☐ Not sure
5. Been acquitted? ☐ Yes ☐ No   ☐ Not sure           
6. Been put on probation? ☐ Yes ☐ No  ☐ Not sure
7. Been placed on deferred adjudication? ☐ Yes ☐ No  ☐ Not sure
8. Been incarcerated? ☐ Yes ☐ No ☐ Not sure
9. Used illegal drugs? ☐ Yes ☐ No  ☐ Not sure
10. Used marijuana or any other narcotic or hallucinogen at a location where the use is legal? ☐ Yes  ☐ No  ☐ Not sure

If so, provide the location, approximate date and drug used:                                                                                                                                                        

11. Abused prescription drugs? ☐ Yes  ☐ No  ☐ Not sure
12. Been hospitalized for drug use? ☐ Yes ☐ No  ☐ Not sure
13. Abused alcohol? ☐ Yes ☐ No   ☐ Not sure
14. Been hospitalized for alcohol use? ☐ Yes ☐ No  ☐ Not sure
15. Attempted suicide? ☐ Yes  ☐ No  ☐ Not sure
16. Been hospitalized for a mental health disorder? ☐ Yes ☐ No ☐ Not sure
17. Received mental health treatment of any kind? ☐ Yes ☐ No  ☐ Not sure
18. Taken prescription medication for your mental health? ☐ Yes ☐ No ☐ Not sure
19. During the marriage (or relationship), had a homosexual or bisexual relationship? ☐ Yes ☐ No ☐N/S
20. During the marriage (or relationship), engaged in unusual sexual practices? ☐ Yes ☐ No  ☐N/S
21. Had a pregnancy outside of marriage? ☐ Yes ☐ No ☐ Not sure
22. Had a sexually transmitted disease? ☐ Yes  ☐ No☐ Not sure
23. Failed to timely or completely pay court-ordered child support? ☐ Yes ☐ No ☐ Not sure
24. Denied court-ordered visitation to another person? ☐ Yes ☐ No ☐ Not sure
25. Executed an affidavit of relinquishment of the parent-child relationship between themselves and a child?☐ Yes ☐ No ☐ Not sure

26. Had the parent-child relationship between themselves and a child terminated? ☐ Yes ☐ No  ☐ Not sure

27. Does the other party drink socially? ☐ Yes ☐ No ☐ Not sure

If so, what do they drink and with what frequency?                                                                                                                                           

Comments related to your answers to the above questions:                                                                                                                                           

If there are any other matters regarding the other party, their lifestyle and their history that might be perceived as negative by others, please briefly summarize these matters:                                                                                                                                                                                                                                                  

HAS THE OTHER PARTY’S SPOUSE (OTHER STEP-PARENT):

1. Been arrested? ☐ Yes ☐ No   ☐ Not sure           
2. Been indicted? ☐ Yes ☐ No ☐ Not sure
3. Been no-billed? ☐ Yes ☐ No  ☐ Not sure
4. Been convicted? ☐ Yes ☐ No  ☐ Not sure
5. Been acquitted? ☐ Yes  ☐ No☐ Not sure           
6. Been put on probation? ☐ Yes ☐ No ☐ Not sure
7. Been placed on deferred adjudication? ☐ Yes ☐ No ☐ Not sure
8. Been incarcerated? ☐ Yes ☐ No  ☐ Not sure
9. Used illegal drugs? ☐ Yes ☐ No ☐ Not sure
10. Used marijuana or any other narcotic or hallucinogen at a location where the use is legal? ☐ Yes ☐ No ☐ Not sure

If so, provide the location, approximate date and drug used: ___________________________________________

___________________________________________________________________________________________

11. Abused prescription drugs? ☐ Yes   ☐ No   ☐ Not sure
12. Been hospitalized for drug use? ☐ Yes ☐ No  ☐ Not sure
13. Abused alcohol? ☐ Yes ☐ No ☐ Not sure
14. Been hospitalized for alcohol use? ☐ Yes ☐ No  ☐ Not sure
15. Attempted suicide? ☐ Yes  ☐ No  ☐ Not sure
16. Been hospitalized for a mental health disorder? ☐ Yes ☐ No ☐ Not sure
17. Received mental health treatment of any kind? ☐ Yes ☐ No   ☐ Not sure
18. Taken prescription medication for your mental health? ☐ Yes ☐ No  ☐ Not sure
19. During the marriage (or relationship), had a homosexual or bisexual relationship? ☐ Y ☐ N  ☐N/S
20. During the marriage (or relationship), engaged in unusual sexual practices? ☐ Y ☐ N    ☐N/S
21. Had a pregnancy outside of marriage? ☐ Yes ☐ No ☐ Not sure
22. Had a sexually transmitted disease? ☐ Yes ☐ No  ☐ Not sure
23. Failed to timely or completely pay court-ordered child support? ☐ Yes ☐ No ☐ Not sure
24. Denied court-ordered visitation to another person? ☐ Yes   ☐ No  ☐ Not sure
25. Executed an affidavit of relinquishment of the parent-child relationship between themselves and a child?  ☐ Yes  ☐ No  ☐ Not sure

26. Had the parent-child relationship between themselves and a child terminated?  ☐ Yes  ☐ No   ☐ Not sure

27. Does the other party’s spouse (other stepparent) drink socially? ☐ Yes ☐ No  ☐ Not sure

If so, what do they drink and with what frequency?                                                                                                                                           

Comments related to your answers to the above questions:                                                                                                                                           

If there are any other matters regarding the other party’s spouse (other stepparent), their lifestyle and their history that might be perceived as negative by others, please briefly summarize these matters:                                                                                                                                                                                                                                                                                                                                                                                                            

CLOSING QUESTIONS:

Why should you be awarded primary custody of your children?                                                                                                                                                                            

Why should the other party not be awarded primary custody of your children?                                                                                                                                                                                                                                                                                                                                                          

If you are awarded primary custody of your children, what type of visitation schedule should the other party be awarded?
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      

When the other party is awarded primary custody of the children, what type of visitation schedule should you be awarded?
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

There are any facts or other issues that were not addressed in this questionnaire, but you believe are important to your custody case, please summarize them below: