Children, Youth and Families (Children's Court Family Division) Rules 2007
i
Children, Youth and Families (Children's Court
Family Division) Rules 2007
S.R. No. 24/2007
TABLE OF PROVISIONS
Rule Page
1 Object 1
2 Authorising provisions 1
3 Commencement 1
4 Definitions 1
5 Forms 1
6 Statement of placement availability—Form 13 2
7 Statutory declaration of undertaking to produce child—Form 14 2
__________________
FORMS 3
Form 1—Application for Temporary Assessment Order 3
Form 2—Temporary Assessment Order 6
Form 3—Application to Vary or Revoke a Temporary Assessment
Order made Without Notice 9
Form 4—Application for Therapeutic Treatment Order 11
Form 5—Therapeutic Treatment Order 13
Form 6—Application for Therapeutic Treatment (Placement) Order 15
Form 7—Therapeutic Treatment (Placement) Order 17
Form 8—Application to Vary or Revoke a Therapeutic Treatment
Order or Therapeutic Treatment (Placement) Order 19
Form 9—Application for Extension of Therapeutic Treatment Order
or Therapeutic Treatment (Placement) Order 21
Form 10—Protection Application 23
Form 11—Irreconcilable Differences Application 27
Form 12—Interim Accommodation Order 29
Form 13—Statement of Placement Availability 31
Form 14—Statutory Declaration of Undertaking to Produce Child 32
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Rule Page
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Form 15—Application to Vary an Interim Accommodation Order or for a
New Order 33
Form 16—Notice to Appear before the Children's Court—Breach
of an Interim Accommodation Order 35
Form 17—Undertaking—Protective Intervention 37
Form 18—Undertaking—Protection Order 38
Form 19—Application to Vary or Revoke an Undertaking 40
Form 20—Supervision Order 42
Form 21—Custody to Third Party Order 44
Form 22—Supervised Custody Order 46
Form 23—Custody to Secretary Order 49
Form 24—Guardianship to Secretary Order 51
Form 25—Long-Term Guardianship to Secretary Order 53
Form 26—Interim Protection Order 55
Form 27—Application for Extension of a Protection Order 57
Form 28—Application to Vary or Revoke a Protection Order 59
Form 29—Application to Revoke a Guardianship to Secretary Order 61
Form 30—Application to Revoke a Long-Term Guardianship to
Secretary Order 63
Form 31—Application for Permanent Care Order 65
Form 32—Permanent Care Order 67
Form 33—Application to Vary or Revoke a Permanent Care Order 69
Form 34—Notice to Appear before the Children's Court—Family
Division 71
Form 35—Application to Restrict Access to a Report 73
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1
STATUTORY RULES 2007
S.R. No. 24/2007
Children, Youth and Families Act 2005
Children, Youth and Families (Children's Court
Family Division) Rules 2007
The President together with 2 magistrates for the Children's
Court of Victoria jointly make the following Rules:
1 Object
The object of these Rules is to prescribe certain
matters and forms for the purposes of the Family
Division of the Court.
2 Authorising provisions
These Rules are made under section 588 of the
Children, Youth and Families Act 2005 and all
other enabling powers.
3 Commencement
These Rules come into operation on 23 April
2007.
4 Definitions
In these Rules—
the Act means the Children, Youth and Families
Act 2005.
5 Forms
The forms in these Rules must be used for or with
respect to proceedings in the Family Division of
the Court.
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6 Statement of placement availability—Form 13
For the purposes of section 263(1)(f) and (g) of
the Act, a statement of placement availability is in
the prescribed form if it is in the form of Form 13.
7 Statutory declaration of undertaking to produce
child—Form 14
For the purposes of section 263(2) of the Act, a
statutory declaration of undertaking to produce
child is in the prescribed form if it is in the form
of Form 14.
__________________
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FORMS
FORM 1
Rule 5
Children, Youth and Families Act 2005
(Sections 228, 229)
APPLICATION FOR TEMPORARY ASSESSMENT ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Grounds for the application
The Secretary—
(a) has a reasonable suspicion that the child is, or is likely to be, in need
of protection; and
(b) is of the opinion that further investigation and assessment of the
matter is warranted; and
(c) is of the opinion that the investigation and assessment cannot properly
proceed unless a temporary assessment order is made.
Details of the application
The Secretary applies for—
*authorisation to enter the premises where the child is living;
*a requirement that the parent of the child or any person with whom the child
is living permit the Secretary to enter the premises where the child is living;
*a requirement that the parent of the child or any person with whom the child
is living permit the Secretary to interview the child and take the child to a
place to be determined by the Secretary for that interview;
*authorisation, subject to section 233, for the child to be medically examined
by a registered medical practitioner or a registered psychologist;
Form 1
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*a direction that the parent of the child or any person with whom the child is
living permit the Secretary to take the child for that medical examination;
*authorisation for the results of the medical examination to be given to the
Secretary;
*a requirement that the parent of the child or any person with whom the child
is living attend an interview with the Secretary and subject to section 234,
answer any questions put to them in the interview;
*the following directions or conditions (provide a brief description)—
Applicant's Name—
Agency and address—
Phone—
Date—
(Signature)
*Application for Temporary Assessment Order (without giving notice)
pursuant to Section 229
The Secretary applies for leave for the application to be heard without
giving notice under section 228 and is satisfied that the giving of such
notice is inappropriate in the circumstances.
Notice to the parties
To the Applicant—You must come to the hearing of this application.
*To the child—You are directed to appear at Court for the hearing of this
application.
*To the parent(s)—You are directed to produce the child at Court for the
hearing of this application.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Form 1
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Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 1
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FORM 2
Rule 5
Children, Youth and Families Act 2005
(Sections 230–234, 236, 238)
TEMPORARY ASSESSMENT ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Applicant's Name—
Agency and address—
Phone—
*The Children's Court is satisfied that—
the making of a temporary assessment order is in the best interests of the
child; and
it is necessary for the Secretary to assess whether or not the child is in
need of protection; and
the Secretary cannot properly carry out an investigation or assessment
unless the order is made.
*The Children's Court grants an application to vary the terms of the
temporary assessment order made on (date) in respect of the child.
Details of the order
*The Court makes a temporary assessment order under section *228/*229 of
the Children, Youth and Families Act 2005.
*The Court orders that the term(s) of the temporary assessment order made
on (date) be varied.
Form 2
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The temporary assessment order—
* authorises the Secretary to enter the premises where the child is
living— (address);
*requires (name) to permit the Secretary to enter the premises where the
child is living— (address);
*requires (name) to permit the Secretary to interview the child and to take
the child to a place to be determined by the Secretary for that interview;
*authorises, subject to section 233, the medical examination of the child
by a registered medical practitioner or a registered psychologist;
*directs (name) to permit the Secretary to take the child for that medical
examination;
*authorises the results of the medical examination to be given to the
Secretary;
*requires (name) to attend an interview with the Secretary and, subject to
section 234, to answer any questions put to them in the interview;
*any direction or condition— (specify).
This order remains in force for (specify number) days beginning from (date).
The Secretary must provide to the Court by (date) a report in writing setting
out the matters referred to in section 238(2).
If this order is made under section 229, the child or a parent of the child may
apply to the Court pursuant to section 235 for the variation or revocation of
this order.
Order made at— (venue)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
Notes
(1) Despite this order, a registered medical practitioner or registered
psychologist must not examine the child if—
(a) the medical practitioner or psychologist is of the opinion that
the child has sufficient understanding to give or refuse consent
to the examination; and
(b) the child refuses that consent.
Form 2
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(2) Despite this order a person may refuse to answer a question put by the
Secretary in an interview authorised by the order if—
(a) to answer might tend to incriminate the person; or
(b) the information is privileged on the ground of legal
professional privilege.
__________________
Form 2
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FORM 3
Rule 5
Children, Youth and Families Act 2005
(Section 235)
APPLICATION TO VARY OR REVOKE A TEMPORARY
ASSESSMENT ORDER MADE WITHOUT NOTICE
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order
On the application of— (full name)
Agency and address—
Phone—
The Children's Court at (venue) on (date) made a temporary assessment order
under section 229 of the Act.
Details of the application
This application is—
*to vary the order
*to revoke the order
The grounds for this application are— (set out grounds)
Form 3
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This application is made—
*by the child
*by a parent of the child
Applicant's name—
Address—
Phone—
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 3
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FORM 4
Rule 5
Children, Youth and Families Act 2005
(Section 246)
APPLICATION FOR THERAPEUTIC TREATMENT ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the application
The Secretary is satisfied on the following grounds that— (set out the
grounds)
the child is in need of therapeutic treatment.
Applicant's Name—
Agency and address—
Phone—
Date—
(Signature)
Notice to the parties
To the applicant and child— You must come to the hearing of this
application.
To the parent(s) of the child— You are directed to produce the child at
Court for the hearing of this application.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Form 4
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Issued at—
Date—
Registrar
_________________
Form 4
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FORM 5
Rule 5
Children, Youth and Families Act 2005
(Sections 248-251)
THERAPEUTIC TREATMENT ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Applicant's name—
Agency and address—
Phone—
*The Children's Court is satisfied that—
(a) the child has exhibited sexually abusive behaviours; and
(b) a therapeutic treatment order is necessary to ensure the child's access
to, or attendance at, an appropriate therapeutic treatment program.
*The Children's Court grants an application to extend the therapeutic
treatment order made on (date) in respect of the child.
*The Children's Court grants an application to vary the condition(s) of the
therapeutic treatment order made on (date) in respect of the child.
Details of the order
*The Court makes a therapeutic treatment order.
*The Court orders that the therapeutic treatment order made on (date) be
extended.
*The Court orders that the condition(s) of the therapeutic treatment order
made on (date) be varied.
Form 5
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The child is required to participate in a therapeutic treatment program (give
details of program, agency and address).
*(Name) is to take any necessary steps to enable the child to participate in the
therapeutic treatment program.
*the child is to permit reports of his or her progress and attendance at the
therapeutic treatment program to be given to the Secretary.
*any other conditions (specify)
This therapeutic treatment order remains in force until (end date).
Order made at— (venue name)
Date—
*Judge/*Magistrate
* Delete if not applicable
Note
Any statement made by the child when participating in the therapeutic
treatment program under this order is not admissible in any criminal
proceedings in relation to the child.
_________________
Form 5
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FORM 6
Rule 5
Children, Youth and Families Act 2005
(Section 252)
APPLICATION FOR THERAPEUTIC TREATMENT (PLACEMENT)
ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
The Children's Court at (venue) on (date) made a therapeutic treatment order
in respect of the child.
Details of the application
The Secretary applies for a therapeutic treatment (placement) order on the
following grounds— (set out grounds)
Applicant's Name—
Agency and address—
Phone—
Date—
(Signature)
Notice to the parties
To the applicant and child— You must come to the hearing of this
application.
Form 6
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Details of the hearing
A hearing of this application will be held at (time) a.m./p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
__________________
Form 6
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FORM 7
Rule 5
Children, Youth and Families Act 2005
(Sections 252–254)
THERAPEUTIC TREATMENT (PLACEMENT) ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Applicant's name—
Agency and address—
Phone—
*The Children's Court made a therapeutic treatment (placement) order in
respect of the child and the Children's Court is satisfied that a therapeutic
treatment (placement) order is necessary for the treatment of the child.
*The Children's Court grants an application to extend the therapeutic
treatment (placement) order made on (date) in respect of the child.
*The Children's Court grants an application to vary the condition(s) of the
therapeutic treatment (placement) order made on (date) in respect of the
child.
Details of the order
*The Court makes a therapeutic treatment (placement) order.
*The Court orders that the therapeutic treatment (placement) order made on
(date) be extended.
*The Court orders that the condition(s) of the therapeutic treatment
(placement) order made on (date) be varied.
Form 7
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The therapeutic treatment (placement) order grants sole custody of the child
to the Secretary but does not affect the guardianship of the child.
The therapeutic treatment (placement) order has the following conditions—
This order remains in force until (end date).
Order made at— (venue name)
on (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 7
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FORM 8
Rule 5
Children, Youth and Families Act 2005
(Sections 257, 258)
APPLICATION TO VARY OR REVOKE A THERAPEUTIC
TREATMENT ORDER OR THERAPEUTIC TREATMENT
(PLACEMENT) ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order that is sought to be varied or revoked—
On the application of— (full name)
Agency and address—
Phone—
*The Children's Court at (venue) on (date) made a therapeutic treatment
order.
*The Children's Court at (venue) on (date) made a therapeutic treatment
(placement) order.
Details of the application
This application is—
*to vary the order (specify conditions to be varied)
*to revoke the order
The grounds for the application are— (set out grounds)
Form 8
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This application is made by—
*the Secretary
*the child
*a parent of the child
Applicant's name—
Address—
Phone—
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 8
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FORM 9
Rule 5
Children, Youth and Families Act 2005
(Section 255)
APPLICATION FOR EXTENSION OF THERAPEUTIC
TREATMENT ORDER OR THERAPEUTIC TREATMENT
(PLACEMENT) ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court at (venue) on (date) made a therapeutic treatment
order.
*The Children's Court at (venue) on (date) made a therapeutic treatment
(placement) order.
Details of the application
The Secretary applies for an extension of—
*the therapeutic treatment order
*the therapeutic treatment (placement) order
The grounds for the application are— (set out grounds)
Applicant's name—
Agency and address—
Phone—
(Signature)
Form 9
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Notice to parties
To the child and applicant— You must come to the hearing of this
application.
To the parent(s)— You should come to the hearing of this application.
If you do not attend, the Court may proceed to hear and determine the
application in your absence.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 9
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FORM 10
Rule 5
Children, Youth and Families Act 2005
(Sections 240(1), 240(3), 243)
PROTECTION APPLICATION
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Grounds for the application
*The child has been abandoned by his or her parents and after reasonable
enquires—
(i) the parents cannot be found; and
(ii) no other suitable person can be found who is willing and able to care
for the child.
*The child's parents are dead or incapacitated and there is no other suitable
person willing and able to care for the child.
*The child has suffered, or is likely to suffer, significant harm as a result of
physical injury and the child's parents have not protected, or are unlikely to
protect, the child from harm of that type.
*The child has suffered, or is likely to suffer, significant harm as a result of
sexual abuse and the child's parents have not protected, or are unlikely to
protect, the child from harm of that type.
*The child has suffered, or is likely to suffer, emotional or psychological
harm of such a kind that the child's emotional or intellectual development is,
or is likely to be, significantly damaged and the child's parents have not
protected, or are unlikely to protect, the child from harm of that type.
*The child's physical development or health has been, or is likely to be,
significantly harmed and the child's parents have not provided, arranged or
allowed the provision of, or are unlikely to provide, arrange or allow the
provision of, basic care or effective medical, surgical or other remedial care.
Form 10
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Applicant's Name—
Agency and Address—
Phone—
Date—
(Signature)
The child *has/*has not been taken into safe custody.
Notice to Parents and child
To the child— You must come to the hearing of this application.
To the parent(s)— If your child is in your custody, the child must appear or
be produced before the Court for the hearing of this application.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address)
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 10
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Reverse
Affidavit/Declaration of Service of Protection Application
I (full name) of (address)
(occupation)
*swear/declare that I served a true copy of this notice on—
(name of person served) who is the (capacity e.g. mother/father/child) on
(date) at a.m./*p.m.
by—
*delivering it to *him/her personally at (address)
*leaving it for *him/her at (address)
being that person's last known place of *residence/*business with a person
who apparently resided or worked there and who apparently was not less than
16 years of age.
*posting it by prepaid ordinary post at (address of posting)
in an envelope addressed to that person at his or her last known place of
*residence/*business. I obtained this address from (insert relevant details).
AND on (name of person served) who is the (capacity e.g. mother/father/
child) on (date) at a.m./*p.m.
by—
*delivering it to *him/her personally at (address)
*leaving it for *him/her at (address)
being that person's last known place of *residence/*business with a person
who apparently resided or worked there and who apparently was not less than
16 years of age.
*posting it by prepaid ordinary post at (address of posting)
in an envelope addressed to that person at his or her last known place of
*residence/*business. I obtained this address from (insert relevant details).
AND on (name of person served) who is the (capacity e.g. mother/father/
child) on (date) at a.m./*p.m.
by—
*delivering it to *him/her personally at (address)
*leaving it for *him/her at (address)
Form 10
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being that person's last known place of *residence/*business with a person
who apparently resided or worked there and who apparently was not less than
16 years of age.
*posting it by prepaid ordinary post at (address of posting)
in an envelope addressed to that person at his or her last known place of
*residence/*business. I obtained this address from (insert relevant details).
*Sworn at in the State of Victoria
on (date)
(Signature of person making affidavit)
Before—
(Name and address in legible writing, typing or stamp)
OR
*I acknowledge that this declaration is true and correct and make it in the
belief that a person making a false declaration is liable to the penalties of
perjury.
Declared at in the State of Victoria
on (date)
(Signature of person making declaration)
Before—
(Name and address of person taking the declaration in legible writing, typing
or stamp)
* Delete if not applicable
__________________
Form 10
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FORM 11
Rule 5
Children, Youth and Families Act 2005
(Sections 259, 260)
IRRECONCILABLE DIFFERENCES APPLICATION
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the application
Name of Parent or Custodian—
Address—
Relationship to the Child— *Mother/*Father/*Relative (state relationship)/
*Custodian
Grounds for the application
*If the applicant is a person who has custody of the child
I believe that there is a substantial and presently irreconcilable difference
between the child and me to such an extent that the care and control of the
child are likely to be seriously disrupted.
*If the applicant is the child
I believe that there is a substantial and presently irreconcilable difference
between me and the person who has custody of me to such an extent that my
care and control are likely to be seriously disrupted.
Applicant's name—
Agency and address—
Phone—
Form 11
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Date—
(Signature)
Notice to custodian or child
To the child— You must come to the hearing of this application.
To the person who has custody of the child— You should come to the
hearing of this application. If you do not attend, the Court may proceed to
hear and determine the application in your absence.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 11
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FORM 12
Rule 5
Children, Youth and Families Act 2005
(Sections 262, 263)
INTERIM ACCOMMODATION ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Applicant's name—
Agency and address—
Phone—
Grounds for making this interim accommodation order—
(set out grounds)
A hearing in this case will take place at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Interim accommodation order
Until further order, I order that the child is to be—
*released on the signing by the child of an undertaking to appear on the
hearing, or the resumption of the hearing, of the relevant proceeding.
*released into the care of (name of parent) who is his or her parent
pending that hearing or resumption on the entering into (whether orally or
in writing) by that parent of an undertaking to produce the child before
the Court for the hearing, or the resumption of the hearing of the relevant
proceeding.
Form 12
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*placed with (name of person(s)) who is (are) a suitable person(s)
pending that hearing or resumption on the entering into (whether orally or
in writing) by that person or those persons of an undertaking to produce
the child before the Court for the hearing, or the resumption of, the
hearing of the relevant proceeding, and following a report (whether oral
or written) from the Secretary on that person's or those persons'
suitability.
*placed in an out of home care service pending that hearing or
resumption.
*placed in a secure welfare service pending that hearing or resumption as
there is a substantial and immediate risk of harm to the child.
*placed in a declared hospital on the provision to the Court or bail justice
of a statement in the prescribed form by or on behalf of the chief
executive of the hospital that a bed is available for the child at the
hospital.
*placed in a declared parent and baby unit on the provision to the Court
or bail justice of a statement in the prescribed form by or on behalf of the
chief executive of the agency managing the parent and baby unit that a
place is available for the child at the parent and baby unit.
The following conditions apply to this Order— (set out conditions)
Undertaking
I undertake to *appear/*produce the child before the Court for the hearing or
resumption of the proceeding.
(Signature)
Order made at—(venue name)
on— (date)
*Judge/*Magistrate/*Bail Justice
__________________
Form 12
-- 32 of 77 --
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Children, Youth and Families (Children's Court Family Division) Rules 2007
31
FORM 13
Rule 6
Children, Youth and Families Act 2005
(Sections 263(1)(f), 263(1)(g))
STATEMENT OF PLACEMENT AVAILABILITY
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
I, (name) *being the/* on behalf of the chief executive officer of (name of
hospital or name of agency managing a declared parent and baby unit) state
that there is a *bed/*place available for (name of child) at (name of hospital
or name of declared parent and baby unit).
Date—
(Signature)
Name—
* Delete if not applicable
__________________
Form 13
-- 33 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
32
FORM 14
Rule 7
Children, Youth and Families Act 2005
(Section 263(2))
STATUTORY DECLARATION OF UNDERTAKING TO PRODUCE
CHILD
I, (full name) of (address), (occupation), declare that I undertake to produce
the child named (full name)
born (date of birth)
before the Children's Court at (venue) on (date) at (time) for the hearing, or
the resumption of the hearing, of the following proceeding (state type of
proceeding).
I acknowledge that this declaration is true and correct and make it in the
belief that a person making a false declaration is liable to the penalties of
perjury.
Declared at (place)
in the State of Victoria on (date)
Before—(Signature)
(name and address in legible writing, typing or stamp below signature)
a person authorised under section 107A(1) of the Evidence Act 1958 to
witness the signing of a statutory declaration.
__________________
Form 14
-- 34 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
33
FORM 15
Rule 5
Children, Youth and Families Act 2005
(Sections 268, 270)
APPLICATION TO VARY AN INTERIM ACCOMMODATION
ORDER OR FOR A NEW ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the interim accommodation order
The Children's Court at (venue) on (date) made an interim accommodation
order.
Details of this application
This application is—
*to vary the order.
*for a new interim accommodation order.
The grounds for the application are— (set out grounds)
Applicant's name—
Agency and address—
Phone—
Date—
(Signature)
Form 15
-- 35 of 77 --
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Children, Youth and Families (Children's Court Family Division) Rules 2007
34
Note
The applicant must give notice of this application to the person who applied
for the interim accommodation order and any other party to the proceeding in
which that order was made and any person with whom the child is living.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 15
-- 36 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
35
FORM 16
Rule 5
Children, Youth and Families Act 2005
(Section 269)
NOTICE TO APPEAR BEFORE THE CHILDREN'S COURT—
BREACH OF AN INTERIM ACCOMMODATION ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order
The Children's Court at (venue) on (date) made an interim accommodation
order.
Details of this notice
Reason for the service of this notice—
The interim accommodation order or any condition of the order has not been,
or is not being complied with (give details).
Applicant's name—
Agency and address—
Phone—
Date—
(Signature)
Form 16
-- 37 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
36
Notice to parent or child
To the child— You must appear before the Court on the date and at the time
listed below.
To the parent(s) or other person with whom the child is living— You
must bring the child to Court on the date and at the time listed below.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
__________________
Form 16
-- 38 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
37
FORM 17
Rule 5
Children, Youth and Families Act 2005
(Sections 272, 273)
UNDERTAKING—PROTECTIVE INTERVENTION
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court makes an order requiring an undertaking to be given
by a person.
*The Children's Court grants an application to vary the undertaking or the
condition(s) of the undertaking made on (date) and the undertaking or
condition(s) of the undertaking are varied.
Details of the undertaking
(name), *the child/*the parent of the child/*the person with whom the child
is living, gives the following undertaking— (set out details of undertaking)
This undertaking remains in force until (end date).
I consent to the making of this order and agree to comply with this
undertaking.
(Signature)
*Child/*Parent/*Custodian
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 17
-- 39 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
38
FORM 18
Rule 5
Children, Youth and Families Act 2005
(Sections 278, 279)
UNDERTAKING—PROTECTION ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection. The Court makes an order requiring an undertaking to be given.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted. The Court makes an order requiring an undertaking to
be given.
*The Children's Court grants an application to vary the undertaking or the
condition(s) of the undertaking in respect of the child given on (date) and the
undertaking or condition/s of the undertaking are varied.
*The Children's Court grants an application to revoke the protection order
made on (date) in respect of the child and makes an order requiring a person
to give an undertaking.
Details of the undertaking
(name), *the child/*the parent of the child/*the person with whom the child
is living gives the following undertaking— (set out details of undertaking)
This undertaking remains in force until (end date).
Form 18
-- 40 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
39
I consent to the making of this order and agree to comply with this
undertaking.
(Signature)
*Child/*Parent/*Custodian
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 18
-- 41 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
40
FORM 19
Rule 5
Children, Youth and Families Act 2005
(Sections 273, 279)
APPLICATION TO VARY OR REVOKE AN UNDERTAKING
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the undertaking
The Children's Court at (venue) on (date) made an order requiring the
*child/*parent/*person with whom the child is living (specify) to give an
undertaking pursuant to section *272/*278 of the Act.
Details of the application
This application is—
*to vary the undertaking (specify the conditions to be varied)
*to revoke the undertaking.
The grounds for the application are— (set out grounds)
Applicant's name—
Agency and address—
Phone—
Date—
(Signature)
Form 19
-- 42 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
41
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 19
-- 43 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
42
FORM 20
Rule 5
Children, Youth and Families Act 2005
(Sections 280–282, 293–294, 296, 298–301, 310, 318)
SUPERVISION ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted.
*The Children's Court grants an application to extend the supervision order
made on (date) in respect of the child.
*The Children's Court grants an application to vary the condition(s) of the
supervision order made on (date) in respect of the child.
*The Children's Court grants an application to revoke the protection order
made on (date) and a supervision order is made in respect of the child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
Details of the order
*The Court orders that the child be placed on a supervision order.
*The Court orders that the supervision order made on (date) be extended.
*The Court orders that the condition(s) of the supervision order made on
(date) be varied.
This order remains in force *until (end date)/*until the current application to
extend the order is determined by the Court.
Form 20
-- 44 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
43
The child is to be placed in the day to day care of the child's parent(s)
(name(s)).
A supervision order gives the Secretary responsibility for the supervision of
the child but does not affect the custody or guardianship of the child.
The following conditions apply to this supervision order—
(set out conditions)
*(If the order remains in force for a period exceeding 12 months from
(date))— The Court directs the Secretary to review the operation of this order
before the end of the period of 12 months after (date) and to notify the Court,
the child, the child's parent(s) and the following person(s) (specify) before the
end of that period if the Secretary considers that it is in the best interests of
the child for this order to continue for the duration of the period specified in
this order.
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 20
-- 45 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
44
FORM 21
Rule 5
Children, Youth and Families Act 2005
(Sections 283, 299–301, 310)
CUSTODY TO THIRD PARTY ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted.
*The Children's Court grants an application to vary the conditions(s) of a
custody to third party order made on (date) in respect of the child.
*The Children's Court grants an application to revoke a protection order
made on (date) and a custody to third party order is made in respect of the
child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
Details of the order
*The Court orders that *sole/*joint custody of the child be granted to—
Name(s)—
Address—
Form 21
-- 46 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
45
*The Court orders that the condition(s) of the custody to third party order
made on (date) be varied. That order grants *sole/*joint custody to—
Name(s)—
Address—
This order does not affect the guardianship of the child.
This order remains in force until (end date).
The following conditions apply to this custody to third party order—
(set out conditions)
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 21
-- 47 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
46
FORM 22
Rule 5
Children, Youth and Families Act 2005
(Sections 284, 293–294, 296, 298–301, 310, 318)
SUPERVISED CUSTODY ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted.
*The Children's Court grants an application to extend the supervised custody
order made on (date) in respect of the child.
*The Children's Court grants an application to vary the condition(s) of the
supervised custody order made on (date) in respect of the child.
*The Children's Court grants an application to revoke the protection order
made on (date) and a supervised custody order is made in respect of the child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
Details of the order
*The Court order that *sole/*joint custody of the child be granted to—
Name—
Address—
Form 22
-- 48 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
47
*The Court orders that the supervised custody order made on (insert date) be
extended. That order grants *sole/*joint custody of the child to—
Name(s)—
Address—
*The Court orders that the condition(s) of the supervised custody order made
on (date) be varied. That order grants *sole/*joint custody of the child to—
Name(s)—
Address—
This order does not affect the guardianship of the child.
This order remains in force *until (end date)/*until the current application to
extend the order is determined by the Court.
The person who has custody of the child must permit the Secretary to visit
the child at his or her place of residence and carry out the duties of the
Secretary under the order.
The Court directs the parties to take all appropriate steps to enable the re-
unification of the child with his or her parent before the end of the period for
which the order remains in force.
The following conditions apply to this supervised custody order—
Note
If while this order is in force, the Secretary is satisfied that it is in the child's
best interests, the Secretary may in writing direct that the child return to the
sole or joint custody of a parent or the parents of the child. In the event of
such a direction—
(a) the child ceases to be in the custody of the person in whom custody
was vested under this supervised custody order; and
(b) the child is deemed to be in the custody of the parent(s) of the child as
specified in the direction; and
(c) this order ceases to be a supervised custody order and is deemed to be
a supervision order giving the Secretary responsibility for the
supervision of the child and placing the child in the day to day care of
the parent(s).
Form 22
-- 49 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
48
*(If the order remains in force for a period exceeding 12 months from
(date))— The Court directs the Secretary to review the operation of this order
before the end of the period of 12 months after (date) and to notify the Court,
the child, the child's parent and the following person(s) (specify names)
before the end of that period if the Secretary considers that it is in the best
interests of the child for this order to continue for the duration of the period
specified in this order.
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 22
-- 50 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
49
FORM 23
Rule 5
Children, Youth and Families Act 2005
(Sections 287, 293–302, 310)
CUSTODY TO SECRETARY ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted.
*The Children's Court grants an application to extend the Custody to
Secretary Order made on (date) in respect of the child.
*The Children's Court grants an application to vary the condition(s) of the
Custody to Secretary Order made on (date) in respect of the child.
*The Children's Court grants an application to revoke the protection order
made on (date) and a Custody to Secretary Order is made in respect of the
child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
*The Children's Court finds that exceptional circumstances exist warranting
an interim variation of the condition(s) of the Custody to Secretary Order
made on (date) in respect of the child.
Details of the order
*The Court orders that sole custody of the child be granted to the Secretary.
Form 23
-- 51 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
50
*The Court orders that the Custody to Secretary Order made on (date) be
extended.
*The Court orders that the condition(s) of the Custody to Secretary Order
made on (date) be varied.
*This order is an interim variation pending the final determination of an
application to vary the Custody to Secretary Order.
*This order remains in force *until (end date)/*until the current application
to extend the order is determined by the Court.
Note
A Custody to Secretary Order grants sole custody to the Secretary but does
not affect the guardianship of the child.
The following conditions apply to this Custody to Secretary Order—
(set out conditions)
*(If the order remains in force for a period exceeding 12 months from
(date))— The Court directs the Secretary to review the operation of this order
before the end of the period of 12 months after (date) and to notify the Court,
the child, the child's parent and the following person(s) (specify) before the
end of that period if the Secretary considers that it is in the best interests of
the child for this order to continue for the duration of the period specified in
this order.
*The Court directs the Secretary to take steps to ensure that at the end of the
period of the order a person other than the child's parent applies to a court for
an order relating to the child's—
(a) custody; or
(b) custody and guardianship; or
(c) custody and joint guardianship.
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 23
-- 52 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
51
FORM 24
Rule 5
Children, Youth and Families Act 2005
(Sections 289, 293–298, 310)
GUARDIANSHIP TO SECRETARY ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted.
*The Children's Court grants an application to extend the Guardianship to
Secretary Order made on (date) in respect of the child.
*The Children's Court grants an application to revoke the protection order
made on (date) and a Guardianship to Secretary Order is made in respect of
the child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
Details of the order
*The Court orders that custody and guardianship of the child be granted to
the Secretary to the exclusion of all other persons.
*The Court orders that the Guardianship to Secretary Order made on (date)
be extended. That order grants custody and guardianship of the child to the
Secretary to the exclusion of all other persons.
*This order remains in force until (end date).
Form 24
-- 53 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
52
*(If the order remains in force for a period exceeding 12 months from
(date))— The Court directs the Secretary to review the operation of this order
before the end of the period of 12 months after (date) and to notify the Court,
the child, the child's parent and the following person(s) (specify) before the
end of that period if the Secretary considers that it is in the best interests of
the child for this order to continue for the duration of the period specified in
this order.
*The Court directs the Secretary to take steps to ensure that at the end of the
period of the order a person other than the child's parent applies to a court for
an order relating to the child's—
(a) custody; or
(b) custody and guardianship; or
(c) custody and joint guardianship.
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 24
-- 54 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
53
FORM 25
Rule 5
Children, Youth and Families Act 2005
(Sections 290, 310)
LONG-TERM GUARDIANSHIP TO SECRETARY ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
*The Children's Court *has found/*finds that the child is in need of
protection.
*The Children's Court *has found/*finds that there is a substantial and
irreconcilable difference between the person who has custody of the child and
the child to such an extent that the care and control of the child are likely to
be seriously disrupted.
*The Children's Court grants an application to revoke the protection order
made on (date) and a Long-term Guardianship to Secretary Order is made in
respect of the child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
The Court is satisfied that—
(a) there is a person or persons available with whom the child will
continue to live for the duration of the order; and
(b) the Secretary consents to the making of the order; and
(c) the child consents to the making of the order; and
(d) the making of the order is in the best interests of the child.
Form 25
-- 55 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
54
Details of the order
The Court orders that custody and guardianship of the child be granted to the
Secretary to the exclusion of all other persons.
This order remains in force until the child attains the age of 18 years or
marries, whichever happens first.
The Court directs the Secretary to review the operation of this order before
the end of each period of 12 months after the making of this order and to
notify the Court, the child, the child's parent and the following person(s)
(specify) before the end of that period if the Secretary considers that, to
ensure the safety and wellbeing of the child, the order should continue for a
further period of 12 months.
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 25
-- 56 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
55
FORM 26
Rule 5
Children, Youth and Families Act 2005
(Sections 291, 299–301, 303–304, 318)
INTERIM PROTECTION ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Applicant's name—
Agency and address—
Phone—
*The Children's Court finds that the child is in need of protection.
*The Children's Court finds that there is a substantial and irreconcilable
difference between the person who has custody of the child and the child to
such an extent that the care and control of the child are likely to be seriously
disrupted.
*The Children's Court grants an application to vary the condition(s) of the
interim protection order made on (date) in respect of the child.
*The Children's Court grants an application to revoke the protection order
made on (date) and an interim protection order is made in respect of the
child.
*The Children's Court finds proved a breach of the protection order made on
(date) in respect of the child.
Details of the order
*The Court orders that the child be placed on an interim protection order.
*The Court orders that the condition(s) of the interim protection order made
on (date) be varied.
Form 26
-- 57 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
56
The Secretary is accountable to the Court for the implementation of this
order.
(name) is to have the responsibility for the supervision of the child.
The Court directs the preparation and submission to the Court of an
additional report by (state person).
This order remains in force until (end date).
The following conditions apply to this Interim Protection Order—
(set out conditions)
Details of the further hearing
The further hearing of this case will be held at (time) a.m./*p.m. on (date) at
the Children's Court at (venue name and address).
Order made at— (venue name)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 26
-- 58 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
57
FORM 27
Rule 5
Children, Youth and Families Act 2005
(Sections 293, 294)
APPLICATION FOR EXTENSION OF A PROTECTION ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
The Children's Court at (venue) on (date) made—
*a supervision order
*a supervised custody order
*a custody to Secretary order
*a guardianship to Secretary order
in respect of the child until (end date).
*The Secretary has directed that on (date) the child return to the sole or joint
custody of a parent or parents and accordingly, pursuant to section 286(1)(c)
of the Act, the supervised custody order has been deemed to be a supervision
order.
*(If the order has since been extended) The Children's Court at (venue) on
(date) last extended this order until (end date).
Details of the application
The Secretary applies for—
an extension of the *supervision order/*supervised custody order/*custody to
Secretary order/*guardianship to Secretary order for a period of (insert
period).
Applicant's name—
Agency and address—
Form 27
-- 59 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
58
Phone—
(Signature)
Notice to parties
To the child and applicant— You must come to the hearing of this
application.
To the parent(s)— You should come to the hearing of this application.
If you do not attend, the Court may proceed to hear and determine the
application in your absence.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 27
-- 60 of 77 --
S.R. No. 24/2007
Children, Youth and Families (Children's Court Family Division) Rules 2007
59
FORM 28
Rule 5
Children, Youth and Families Act 2005
(Sections 300, 304)
APPLICATION TO VARY OR REVOKE A PROTECTION ORDER
(Not for undertakings or for Guardianship to Secretary Order or for
Long-term Guardianship to Secretary Order)
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the original order (not details of any subsequent variation or
extension)
The Children's Court at (venue) on (date) made the following order—
*a supervision order
*a custody to third party order
*a supervised custody order
*a custody to Secretary order
*an interim protection order
*The Secretary has directed that on (date) the child return to the sole or joint
custody of a parent or parents and accordingly, pursuant to section 286(1)(c)
of the Act, the supervised custody order has been deemed to be a supervision
order.
Details of this application
This application is—
*to vary the order (specify the condition(s) to be varied)
*to revoke the order
Form 28
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The grounds for the application are—
(set out grounds)
This application is made by—
* the child
* a parent of the child
* a person with whom the child is living
* a person who has been granted custody of the child
* the Secretary
Applicant's name—
Address—
Phone—
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 28
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FORM 29
Rule 5
Children, Youth and Families Act 2005
(Section 305)
APPLICATION TO REVOKE A GUARDIANSHIP TO SECRETARY
ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order
The Children's Court at (venue) on (date) made a Guardianship to Secretary
Order in respect of the child which was to remain in force until (end date).
(If the order has since been extended)
*The Children's Court at (venue) on (date) last extended this order until (end
date).
Details of the application
This application is made on the grounds that—
*circumstances have changed since the making of the Guardianship to
Secretary Order and the applicant has asked the Secretary to review the
case plan and the Secretary has either refused to review the case plan or
has reviewed it in a way which the applicant finds unsatisfactory.
*the Secretary makes a notification in accordance with section 289(2) of
the Act in respect of the order.
*(State any other grounds)
Applicant's name—
Agency and address—
Phone—
Form 29
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The applicant is *the child/*a parent of the child/*the Secretary
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 29
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FORM 30
Rule 5
Children, Youth and Families Act 2005
(Section 306)
APPLICATION TO REVOKE A LONG-TERM GUARDIANSHIP TO
SECRETARY ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order
The Children's Court at (venue) on (date) made a Long-term Guardianship to
Secretary Order in respect of the child.
Details of this application
This application is to revoke the order.
The grounds for the application are— (set out grounds)
This application is made—
*by the child
*by a parent of the child
*by the Secretary
(If this application is made by a parent of the child and the order has been in
force for more than 12 months)
*I hereby apply for leave pursuant to section 306(3) of the Act to make this
application.
Applicant's name—
Address—
Form 30
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Phone—
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 30
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FORM 31
Rule 5
Children, Youth and Families Act 2005
(Section 320)
APPLICATION FOR PERMANENT CARE ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the application
Applicant's name—
Agency and address—
Phone—
(Signature)
Name of child's mother—
Address—
Name of child's father—
Address—
Name of proposed carer 1—
Address—
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Name of proposed carer 2—
Address—
Relationship of carer(s) to child: *Relative(s) (specify)
*Foster parent(s)
*Other— (specify)
The applicant applies for a permanent care order in respect of the child.
A protection order *is/*is not in force in respect of the child. (If a protection
order is in force, set out relevant details—)
An application to revoke the protection order *has/*has not been made.
It *has/*has not been determined.
There *are/*are not current proceedings under the Family Law Act 1975 of
the Commonwealth with respect to the custody and guardianship of the child,
being a proceeding commenced by a person who is not a parent of the child,
details of which are as follows— (set out details, including who commenced
such proceedings)
Notice to parties
To the child and applicant— You must come to the hearing of this
application.
To the parent(s) and proposed carer(s)— You should come to the hearing
of this application. If you do not attend, the Court may proceed to hear and
determine the application in your absence.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 31
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FORM 32
Rule 5
Children, Youth and Families Act 2005
(Sections 319, 321)
PERMANENT CARE ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Name of child's mother—
Address—
Name of child's father—
Address—
*The Children's Court grants a permanent care application in respect of the
child.
*The Children's Court grants an application to vary the condition(s) of the
permanent care order made on (date) in respect of the child.
Details of the order
*The Court makes a permanent care order.
*The Court orders that the condition(s) of the permanent care order made on
(date) be varied.
Custody and guardianship of the child is granted to—
Form 32
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Name—
Address—
Name—
Address—
*Guardianship of the child is vested jointly in—(names and addresses)
The following conditions apply to this permanent care order—
(set out conditions)
Order made at— (venue)
on— (date)
*Judge/*Magistrate
* Delete if not applicable
__________________
Form 32
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FORM 33
Rule 5
Children, Youth and Families Act 2005
(Section 326)
APPLICATION TO VARY OR REVOKE A PERMANENT CARE
ORDER
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Applicant's name—
Agency and address—
Phone—
The applicant is—
*the child
*a parent of the child
*a person granted custody and guardianship of the child under the order
*the Secretary
The parents of the child are— (names and addresses)
Details of the Permanent Care Order being sought to be varied or
revoked
The Children's Court at (venue) on (date) made an order granting custody and
guardianship of the child to (names and addresses)
Form 33
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Details of this application
This application is—
*to vary the permanent care order
*to revoke the permanent care order
The grounds for the application are— (set out grounds)
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 33
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FORM 34
Rule 5
Children, Youth and Families Act 2005
(Section 312)
NOTICE TO APPEAR BEFORE THE CHILDREN'S COURT—
FAMILY DIVISION
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order
The Children's Court at (venue) on (date) made—
*a supervision order
*a supervised custody order
*an interim protection order
*The Secretary has directed that on (date) the child return to the sole or joint
custody of a parent or parents and accordingly, pursuant to section 286(1)(c)
of the Act, the supervised custody order has been deemed to be a supervision
order.
Details of this notice
Reason for the service of this notice—
*There has been a failure to comply with a condition of the order (give
details)
*There has been a failure to comply with a direction given by the
Secretary under section 282(2) of the Act (if supervision order) or section
285(2) of the Act (if supervised custody order). Details of the failure
are— (set out relevant details)
*The child is living in conditions which are unsatisfactory in terms of the
safety and wellbeing of the child. The unsatisfactory conditions are—
(give details)
Form 34
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Applicant's name—
Agency and address—
Phone—
Date—
(Signature)
Notice to parties—
To the child— You must appear before the Court on the date and at the time
listed below.
To the parent(s) or other person with whom the child is living— You
must bring the child to Court on the date and at the time listed below.
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
__________________
Form 34
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FORM 35
Rule 5
Children, Youth and Families Act 2005
(Sections 556, 559, 566, 570)
APPLICATION TO RESTRICT ACCESS TO A REPORT
Court Ref.—
Name of Child—
*Male/*Female
Date of Birth—
Address—
Details of the order for the report
The Children's Court at (venue) on (date) ordered the Secretary to submit to
the Court the following report concerning the child named above—
*protection report
*disposition report
*therapeutic treatment application report
*therapeutic treatment (placement) report
The report is to be considered at a hearing of the relevant application on
(date).
Details of this application
I apply to the Court for an order restricting access by—
*the child who is the subject of the report
*the child's parent
*the following party to the proceeding— (insert name of party)
*any other person specified by the Court namely— (insert name of person
specified)
Form 35
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I seek that access be restricted to—
*the whole report
*a part of the report (specify—)
This application is based on the grounds that the information in the report or
the part of the report may be prejudicial to the physical or mental health of
the child or a parent of the child.
Applicant's name—
Agency and address—
Phone—
Date—
(Signature)
Details of the hearing
A hearing of this application will be held at (time) a.m./*p.m. on (date) at the
Children's Court at (venue name and address).
Issued at—
Date—
Registrar
* Delete if not applicable
Form 35
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Dated: 19 April 2007
PAUL DOUGLAS GRANT,
President of the Children's Court of Victoria
GREGORY LEVINE,
Magistrate
PETER THOMAS POWER,
Magistrate
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Form 35
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