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Application For an Order Form C1

Children Act 1989

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Important Note

You should only answer question 7 if you are asking the court to make one of the following orders:

a Contact Order, a Residence Order, a Prohibited Steps Order, a Specific Issue Order or a Parental Responsibility Order.

1. About you (the person completing this form known as `the applicant')

State:

* your title, full name, address, telephone number, date of birth and relationship to each child above

* your solicitor's name, address, reference, telephone, FAX and DX numbers.

2. The child(ren) and the order(s) you are applying for

For each child state:

* the full name, date of birth and sex

* the type of order(s) you are applying for (for example, residence order, contact order, supervision order).

3. Other cases which concern the child(ren)

If there have ever been, or there are pending, any court cases which concern

attach a copy of the relevant order and give

4. The respondent(s)

Appendix 3 Family Proceedings Rules 1991; Schedule 2 Family Proceedings Courts (Children Act 1989) Rules 1991

For each respondent state:

* the title, full name and address

* the date of birth (if known) or the age

* the relationship to each child.

5. Others to whom notice is to be given

Appendix 3 Family Proceedings Rules 1991; Schedule 2 Family Proceedings Courts (Children Act 1989) Rules 1991)

For each person state:

* the title, full name and address

* the date of birth (if known) or age

* the relationship to each child.

6. The care of the child(ren)

For each child in paragraph 2 state:

* the child's current address and how long the child has lived there

* whether it is the child's usual address and who cares for the child there

* the child's relationship to the other children (if any).

7. Domestic abuse, violence or harm

Do you believe that the child(ren) named above have suffered or are at risk of suffering any harm from any of the following:

* any form of domestic abuse
* violence within the household

* child abduction

* other conduct or behaviour

by any person who is or has been involved in caring for the child(ren) or lives with, or has contact with, the child(ren)?

Please tick the box which applies Yes No

8. Social Services

For each child in paragraph 2 state:

* whether the child is known to the Social Services. If so, give the name of the social worker and the address of the Social Services department.

* whether the child is, or has been, on the Child Protection Register. If so, give the date of registration.

9. The education and health of the child(ren)

For each child state:

* the name of the school, college or place of training which the child attends

* whether the child is in good health. Give details of any serious disabilities or ill health

* whether the child has any special needs.

10. The parent(s) of the child(ren)

For each child state:

* the full name of the child's mother and father

* whether the parents are, or have been, married to each other

* whether the parents live together. If so, where.

* whether, to your knowledge, either of the parents have been involved in a court case concerning a child. If so, give the date and name of the court.

11. The family of the child(ren) (other children)

For any other child not already mentioned in the family (for example, a brother or a half sister) state:

* the full name and address

* the date of birth (if known) or age

* the relationship of the child to you.

12. Other adults

State:

* the full name of any other adults (for example, lodgers) who live at the same address as any child named in paragraph 2

* whether they live there all the time

* whether, to your knowledge, the adult has been involved in a court case concerning a child. If so, give the date and the name of the court.

13. Your reason(s) for applying and any plans for the child(ren)

State briefly your reasons for applying and what you want the court to order.

* Do not give a full statement if you are applying for an order under Section 8 of the Children Act 1989. You may be asked to provide a full statement later.

* Do not complete this section if this form is accompanied by a prescribed supplement.

14. Attending the court

State:

* whether you will need an interpreter at court. If so, please indicate what language interpreter you will use. If you require an interpreter you must notify the court immediately so that one can be arranged

* whether you have a disability for which you require special assistance or special facilities. If so, please say what your needs are. The court staff will get in touch with you about your requirements.

15. Parenting Information - Arrangements after Separation

Signed

(Solicitor for Applicant) Vivienne Geary Date 2009

Head of Strategic Projects

and Strategic Procurement

and Monitoring Officer

North Tyneside Council

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