Family Law Intake Sheet

Please return all Intake Forms with other documentation to intake@.

Access Rights/International Parental Abduction Intake Form

Today’s date:

What type of case is this? Access Rights (visitation) International Abduction (initiate a case seeking the return of minor child to another country)

Name

This intake for is required to be filled out to the best of your ability. Names of all parties must be filled in prior to the consultation for conflict checks.

Please State your Top 3 Litigation Goals in Order of Importance:

Examples of Good Goals: “I want to have my son returned to the country where he has resided” “I want visitation or phone contact with my son”.

Examples of Bad Goals: “I want to expose to the world what a liar he/she is”

Goal #1:

Goal #2:

Goal #3:

Personal Data – please fill in all fields

Name

Street Address

City, State, Country, Zip

Home Phone Cell Phone

Is it ok to contact you at the phone numbers listed above?

Personal Email: work email

Do you prefer we use your personal email, work email or both?

All Former Names:

Age: Birth date: nationality:

Children at issue in this case:

CHILD 1

Name:

Age: Sex: Birth date: Place of birth:

Country of citizenship: When will the child be 16 years of age:

Passport number(s): country that issued passport(s):

If the child is not a U.S. citizen, please list any and all U.S. immigration status documents the child has ever had (i.e. tourist visas, permanent resident card, parole, etc.) and state when each document expires:

Who is in possession of all the documents you listed above (passports/visas)?

How did the child enter the U.S.?

Last date child was in his/her country of habitual residence?

Please fill out the table below as to the child’s living arrangements for the last 5 years.

|Time Period |Name of Person the Child(ren) |Address where child resided: street number, City, Municipality,| |

|(mo/yr – mo/yr) |Lived With: |State, Country | |

|i.e., May, 2017 - present |Sue Jones (Mom) | | |

| | |1234 Belmont Drive, Las Vegas, NV, U.S. 89101 | |

|present | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

Is the father listed on the Birth Certificate Yes No

CHILD 2

Name:

Age: Sex: Birth date: Place of birth:

Country of citizenship: When will the child be 16 years of age:

Passport number(s): country that issued passport(s):

If the child is not a U.S. citizen, please list any and all U.S. immigration status documents the child has ever had (i.e. tourist visas, permanent resident card, parole, etc.) and state when each document expires:

Who is in possession of all the documents you listed above (passports/visas)?

How did the child enter the U.S.?

Last date child was in his/her country of habitual residence?

Please fill out the table below as to the child’s living arrangements for the last 5 years.

|Time Period |Name of Person the Child(ren) |Address where child resided: street number, City, Municipality,| |

|(mo/yr – mo/yr) |Lived With: |State, Country | |

|i.e., May, 2017 - present |Sue Jones (Mom) | | |

| | |1234 Belmont Drive, Las Vegas, NV, U.S. 89101 | |

|present | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

Is the father listed on the Birth Certificate Yes No

Other Party – children’s other parent, or opposing party in the case

Name

Address

City, State, Zip

Home Phone Cell Phone

Email: work email

Fax No:

All Former Names:

Age: Birth date: Place of birth:

Country of citizenship:

DETAILS ABOUT YOUR CASE:

Did you consent (whether verbally or in written form) or acquiesced to the other parent bringing your child(ren) to the U.S.?

If yes, explain the circumstances:

If you had custody rights, were you exercising them? If so, how?

Did the other parent consent or acquiesce to the relocation of the child to the U.S.? Please explain:

If the child is of sufficient age and maturity, does he/she object to being returned to his/her habitual residence?

Is the child well settled in the new environment? If so, explain (i.e. he has been in Las Vegas for 10 months, has been going to school and made friends, etc.)

If returned, do you believe the child could be exposed to physical or psychological harm or otherwise be placed in an intolerable situation? If so, explain:

Based on your knowledge, would the return of the child not be permitted by fundamental principles of the country of habitual residence relating to the protection of human rights and fundamental freedoms?

Have you had any contact with the child since the child has resided in the U.S.? (i.e. phone calls, Skype, etc.) if so, please describe when, how often, etc.:

Are you able to travel to the U.S. to attend Court?

If you are requesting that the child return to his/her habitual residence, please state your proposal for return (i.e. person who will pick up and travel with the child to his/her country of habitual residence):

YOUR RELATIONSHIP TO THE OTHER PARENT:

Are you or were you married to the child’s other parent? If so, what is your marriage date? If you are no longer married to the other parent, what is the date of divorce? Date of separation:

In what city, state and country was your divorce granted?

UNDERLYING ORDERS OR JUDGMENTS

Has any judge previously signed any ORDERS or JUDGMENTS in connection with this matter or another matter involving these same parties? YES NO

If yes, in what City, State, Country and Year did this occur?

Are you aware of any ongoing proceedings surrounding this matter? YES NO

EXPLAIN (Please supply Dates, State, Country and Details):

Have you retained any other attorneys on this matter prior to coming to this office? (If yes, please provide name, date retained and reason to discontinue service.)

CUSTODY

Is there an existing custody order?

If so, where and when was it entered?

Current order legal custody: Joint Mother Sole Father Sole

Current order physical custody: Shared Mother Primary Father Primary

Current court ordered regular timeshare:

Mom:

Dad:

Are you following the court ordered schedule?

If not following or no current order – what is current custody schedule?

Mom:

Dad:

If you are only requesting access rights, please state your desired visitation arrangement:

Desired Visitation Arrangement:

WHAT ARE THE WORST THINGS THE OTHER SIDE MIGHT ALLEGE AGAINST YOU (TRUE OR NOT) AND IS THERE ANY BASIS FOR THEM?

Were you referred to a specific attorney? If so to who? _________________________

How did you hear about us?

U.S. Department of State

Nevada State Bar website list of specialists

Legal Aid Center of Southern Nevada

American Association of Matrimonial Lawyers ()

International Association of Family Lawyers ()



Other internet directory: _____________________________

Other internet search: __________________________________

Other Attorney, Attorney’s name: _________________________

Friend, Friend’s name: __________________________________

Other: _______________________________________________

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