Post-Separation Visitation Disputes: Differential Interventions

BACKGROUND PAPER

(2001-FCY-6)

APPENDIX 7: CHILDREN'S LAWYER INTAKE FORM

I. GENERAL INFORMATION

Has the Office of the Children’s Lawyer (previously the Official Guardian) ever been involved with you, the other party and/or your child(ren)?

  • Yes
  • No

If yes, when? DD/MM/YY

II. INFORMATION ABOUT YOURSELF

Name:

Date of Birth: DD/MM/YY

Previous Name (if any):

Place of Birth: (if not born in Canada)
Date of Arrival in Canada DD/MM/YY

Address:

  • No.
  • Street
  • City
  • Province
  • Postal Code

Telephone No.

  • Home
  • Work:
  • Fax No.

Lawyer’s Name (or contact person):

Firm:
Address:

  • No.
  • Street
  • City
  • Province
  • Postal Code

Telephone No.
Fax No.

Are you employed?

  • Yes
  • No

What is your annual income? $

If yes, Business Name:
Address:

  • No.
  • Street
  • City
  • Province
  • Postal Code

III. INFORMATION ABOUT OTHER PARTY

Name:

Date of Birth: DD/MM/YY

Previous Name (if any):

Place of Birth: (if not born in Canada)
Date of Arrival in Canada DD/MM/YY

Address:

  • No.
  • Street
  • City
  • Province
  • Postal Code

Telephone No.

Lawyer’s Name (or contact person):

Firm:
Address:

  • No.
  • Street
  • City
  • Province
  • Postal Code

Telephone No.
Fax No.

Is the other party employed?

  • Yes
  • No

What is the annual income? $
If yes, Business Name:
Address:

  • No.
  • Street
  • City
  • Province
  • Postal Code

IV. SOME GENERAL QUESTIONS

V. INFORMATION ABOUT YOUR CHILD(REN)

[Please attach a separate sheet if there are more children]

VI. OTHER IMPORTANT INFORMATION

VII. INFORMATION ABOUT HELPING YOUR CHILDREN

  • 1. Describe your relationship with the other party. (Please print or write legibly)

  • 2. Please tell us your concerns about custody of and access to
    your child(ren). (Please print or write legibly)

  • 3. How Do you think we can help your child(ren)? (Please print or write legibly)

The following information would be very useful in helping us to understand circumstances your child(ren) are coping with.

VIII. ADDITIONAL INFORMATION

IX. INFORMATION ABOUT THE COURT CASE

Where has the court action been brought?

Address of Court:

  • No.
  • Street
  • City
  • Province
  • Postal Code

Telephone No.
Fax No.

Next Court date: DD/MM/YY
no fixed return date

Nature of next court proceeding:

Name of court proceeding:

X. USE THIS PAGE FOR ANY OTHER INFORMATION

I certify that I have reviewed the above information and that I believe it to be accurate.
Date: DD/MM/YY

Signature of Party
:

[Please attach additional pages, as required, and fax this form
(416-314-8050) to us or send by mail]

Date modified: