Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Fill in child’s name and date of birth:

Child’s Name:

Date of Birth:

Case Number:

Court fills in case number when form is filed.

JV-287

Confidential Information

This form is used to keep contact information confidential. It may be used 
along with any Judicial Council juvenile form, including Request to Change 
Court Order (form JV-180), Application and Affidavit for Restraining Order 
(form JV-245), Relative Information (form JV-285), Caregiver Information 
Form (form JV-290), De Facto Parent Request (form JV-295), and Position on 
Release of Information to Medical Board of California (form JV-228). 

ou do not need to fill out this entire form. Write only the information that you 

his information must be kept under seal in the court file. Only the court, the 

agency, and the child's attorney may look at this information. 

know.  

  Y

  T

1

Your name:

Your telephone number:

Your address:

2

Child’s name:

Child’s telephone number, if known:

Child’s address, if known:

3

If known:

Child’s Indian custodian, if any (name each):

Custodian’s telephone number:

Custodian’s address:

4

If known:

Child’s caregiver (name each):

Caregiver’s telephone number:

Caregiver’s address:

Judicial Council of California, www.courts.ca.gov 
Rev. September 1, 2020, Optional Form  
California Rules of Court, rule 5.534

Confidential Information

JV-287, Page 1 of 1