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JUVENILE COURT PARENT / CHILD INFORMATION Date: Name of Person completing this form: Case (Parent or Associate to the Case) Child(ren) Names DOB Name of child’s father (If known) MOTHER OR ASSOCIATE Your Full Name: Maiden Name: If Associate, What is your relationship to Child(ren): Your Cell Phone Mother’s or Associate #1 Email Mother’s or Associate #1 Physical Street City State Zip Code Mother’s or Associate #1 Employer Company Name & Phone Emergency Contact Name: Telephone As to the Mother: Is the mother legally married right now? □ Yes □ No If Yes, name of spouse: FATHER OR ASSOCIATE Your Full Name: You are the father to what child(ren): If Associate, What is your relationship to Child(ren): Your Cell Phone Father’s or Associate #2 Email Father’s or Associated #2 Physical Street City State Zip Code Father’s or Associate #2 Employer Company Name & Phone Emergency Contact Name: Telephone It is vital to provide accurate and current information as such information will be used to contact parties and to provide notice to parties of hearings. In accordance to O.C.G.A. §15-11-108, written notice may be delivered to parties by U.S. mail, email or hand delivery. It is the responsibility of the parent(s) to notify the clerk of court of any change in the above information. The clerk may be reached at (706) 629-4561 or [EMAIL REDACTED]. ---PAGE BREAK--- PLEASE TURN PAGE OVER AND COMPLETE BACK SIDE OF THIS FORM