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FORM 33B.1

Applicant(s)
 Full legal name & address for service  Lawyer's name & address
 Name


 Street Address, including Suite# (if any)


 City, Province


 Telephone


 Fax numbers


 e-mail address (if any).
 Name


 Street Address, including Suite# (if any)


 City, Province


 Telephone


 Fax numbers


 e-mail address (if any).
  Respondent(s)
   Full legal name & address for service    Lawyer's name & address
 Name


 Street Address, including Suite# (if any)


 City, Province


 Telephone


 Fax numbers


 e-mail address (if any).
 Name


 Street Address, including Suite# (if any)


 City, Province


 Telephone


 Fax numbers


 e-mail address (if any).
  Children's Lawyer
    Name & address of Children's Lawyer's

    Name
   

    Street Address, including Suite# (if any)
   

   City, Province
   

   Telephone
   

   Fax numbers
   

   e-mail address (if any).
   




TO THE APPLICANTS:


If you are making a claim against someone who is not an applicant, insert the person's name and address here.

AND TO: (full legal name)   , an added respondent,

of (address for service of added party)


You must complete, serve, file and update this form if any significant changes regarding the child(ren) occur after you sign this form. If you are the applicant, then do not complete Part 2, Part 3 or Part 5 of this form.



I am / We are (full legal name(s))    

and I am / We are (state your relationship to the child(ren))
PART 1

1. The child(ren) in this case is/are:
Full legal
name		 Birthdate Age Sex








Full Legal
Name of Mother 		Full Legal
Names of Father		 Child's
Religion		 Child's
Native Status








 

2. The following people have had the child(ren) in their care and custody during the past year:
Child's name Name of other caregiver(s) Period of time with caregiver(s)
(d, m, y to d, m, y)






PART 2



3. If this is a child protection application, complete this Part, then go to Part 4. (If this is a status review, complete part 3,
    then go to Part 4.)

          (Check applicable box(es).)
     I/We agree with the following facts in paragraph 6 of the application. (Refer to the numbered paragraph(s) under
          paragraph 6 of the application.)

     I/We disagree with the following facts in paragraph 6 of the application. (Refer to the numbered paragraph(s) under
          paragraph 6 of the application.)

NOTE: If you intend to dispute the children's aid society's position at the temporary care and custody hearing, an affidavit in Form 14 MUST also be served on the parties and filed at court.
PART 3



4. If this is a status review, complete this Part, then go to Part 4. (If this is a protection application, complete Part 2, then
    go to Part 4.)

          (Check applicable box(es).)
     I/We agree with the following facts in paragraph 6 of the application. (Refer to the numbered paragraph(s) under
          paragraph 6 of the application.)

     I/We disagree with the following facts in paragraph 6 of the application. (Refer to the numbered paragraph(s) under
          paragraph 6 of the application.)
PART 4


5. What placement and terms of placement do you believe would be in the child(ren)'s best interest? (You should include
   in your plan of care at least the following information. If your plan is not the same for a particular child, then complete a
   separate plan for that child.)
    (a) Where will you live?
    (b) Who, if anyone, will live with you?
    (c) Where will the child(ren) live?
    (d) What school or daycare will the child(ren) attend?
    (e) What days and hours will the child(ren) attend school or daycare?
    (f) Are you enrolled in school or counselling
    (g) If you are enrolled in counselling, where do you attend counselling?
    (h) What support services will you be using for the child(ren)?
    (i) Do you have support from your family?
    (j) If you have support from your family, who will help you and how will they help you?
    (k) What will the child(ren)'s activity be?
    (l) What will your source of income be?
    (m) Do you go to work or school?
    (n) If you go to work or school, what are the details, including the days and hours you work or go to school, and who will look after your child(ren) while you are there?

    (o) State why you feel that this plan would be in the child(ren)'s best interest.

  1. Where will you live?




  2. Who, if anyone will live with you?




  3. Where will the child(ren) live?




  4. What school or daycare will the child(ren) attend?




  5. What days or hours will the child(ren) attend school or daycare?




  6. Are you enrolled in school or counselling?




  7. If you are enrolled in counselling, where do you attend counselling?




  8. What support services will you be using for the children?



  9. Do you have support from your family?




  10. If you have support from your family, who will help you and how will they help you?




  11. What will the child(ren)'s activity be?




  12. What will your source of income be?




  13. Do you go to work or school?




  14. If you go to work or school, what are the details, including the days and hours you work or go to school, and who will look after your child(ren) while you are there?




  15. State why you feel that this plan would be in the child(ren)'s best interest.





  1. There is a bond of love between mother and daughter. Society Wardship will irrevocably break this bond. Great strides have been made since my daughter's apprehension and she is anxious to return home and live with me and my extended family.



  2. Continued disruption with limited access may create life-long emotional instability and insecurity. I believe that my daughter's Jamaican heritage must be fostered and I am concerned that a prolonged stay in a foster family that does not share my Caribbean culture will be detrimental to my daughter. For some time whilst my daughter was in care, her hair and skin were not being properly cared for. I believe that the particular needs of African-Canadian children must be considered in this context.





6. These are people who have information that would support my plan:
Name Information




















PART 5



Claims by Respondent(s)

(Fill out a separate claim page for each person against whom you are making claim(s))




7. THIS CLAIM IS MADE AGAINST

       THE CHILDREN'S AID SOCIETY (OR OTHER APPLICANT)

       AN ADDED PARTY, whose name is (full legal name)  

    (If you claim against an added party, make sure that the person's name appears on page 1 of this form.)





8. I ASK THE COURT THE FOLLOWING:
(Claims below include for temporary orders.)

 00    access
 01    lesser protection order
 02    return of child(ren) to my/our care
 03    place child(ren) into care of (name)    
 04   children's aid society wardship for       months
 05    society supervision of my/our child(ren)

 10    costs
 11    (Other; specify.)

Give details of the order that you want the court to make. (Include the name(s) of the child(ren) for whom custody or access is claimed.)






IMPORTANT FACTS SUPPORTING MY/OUR CLAIM(S)




(In numbered paragraphs, set out the facts that form the legal basis for your claim(s).)





Put a line through any blank space left on this page












Date of signature       Signature      






Date of signature       Signature      




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