Form 33f Consent To Secure Treatment

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ONTARIO
Court File Number
(Name of Court)
Form 33F: Consent to
Secure Treatment
at
(person other than child)
Court office address
Applicant(s)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
Child
Lawyer’s name & address — street & number, municipality, postal
Full legal name of child:
code, telephone & fax numbers and e-mail address (if any).
Birthdate:
Sex:
Name and address of secure treatment program in this case
My name is
and I am
(full legal name)
the administrator of the secure treatment program. I consent to this application for
the child’s commitment to the program.
an extension of the child’s commitment to the program.
an extension of the commitment to the program of the person admitted into it who has now attained the age of
eighteen years.
the child’s parent. I consent to
this application for the commitment of my child who is in the care of a person other than the administrator of the
secure treatment program.
my child’s commitment to the secure treatment program for a period of 180 days in this application brought by
(full legal name of applicant children’s aid society)
this application by the administrator of the secure treatment program for an extension of my child’s admission to
the program.
an authorized representative of the Minister of Children and Youth Services for Ontario. I consent to the admission of the
child who is less than twelve years old to the secure treatment program.
temporarily while this case for an order of commitment or for an order extending it is adjourned.
on the court’s final order of commitment or extending commitment.
an officer of
(full legal name of children’s aid society)
I am authorized, on behalf of the society, to consent to this application of the administrator of the secure treatment
program for an extension of the child’s commitment to that program.
the person who is the subject of this case. I am 18 years of age or more. I consent to this application to extend my
commitment to the secure treatment program to which I am now admitted.
Signature
Date of signature
Save Form
Print Form
Clear Form
FLR-33F-E (2015/12)
Page 1 of 1

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