Form 35.1 Affidavit In Support Of Claim For Custody Or Access Page 4

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Form 35.1:
Affidavit in Support of Claim for
(page 4)
Court file number
Custody or Access
7. I am now charged with the following criminal offence(s):
Terms of release while waiting for trial
Date of next court
Charge
(attach copy of bail or other
appearance
release conditions, if any)
8. When the court is assessing a person’s ability to act as a parent, s. 24 (4) of the Children’s Law Reform Act requires
the court to consider whether the person has at any time committed violence or abuse against:
his or her spouse;
a parent of the child to whom the claim for custody or access relates;
a member of the person’s household; or
any child.
I am aware of the following violence or abuse the court should consider under s. 24 (4) of the Children’s Law
Reform Act:
(describe incident(s) or episode(s) and provide information about the nature of the violence or abuse, who committed
the violence and who the victim(s) was/were)
9. To the best of my knowledge, since birth, the child(ren) in this case has/have lived with the following caregiver(s):
(including a parent, legal guardian, children’s aid society etc.)
Period(s) of Time with
Name(s) of Caregiver(s)
Child’s Name
Caregiver(s)
(if the child was in the care of a children’s aid society,
give the name of that children’s aid society)
(d,m,y to d,m,y)
FLR-35-1-E (2009/11)
Continued on next sheet

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