Affidavit Of Adoption Of Applicant Page 3
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1
2
3Form 34D:
Affidavit of Adoption of Applicant(s)
(page 3)
Court File Number
Check applicable box.
6.
I am the sole applicant for this child's adoption and if an adoption order is made, I will be the child's only legal parent.
I am the sole applicant for this child’s adoption. If an adoption order is made, I will be joining with
,
(spouse’s full legal name)
who is my spouse within the meaning of Part VII of the Child and Family Services Act, and together, we will be the
child’s only legal parents.
We are applying for this child's adoption jointly as spouses within the meaning of Part VII of the Child and Family
Services Act. If an adoption order is made, we will be the child's only legal parents.
7.
I/We understand and appreciate the special role of an adopting parent.
8.
No payment or reward of any kind was made, given, received or agreed to be made, given or received by me/us or, to the
best of my/our knowledge, by any other person in connection with,
(a) the adoption of this child;
(b) this child’s placement for adoption;
(c) the giving of any consent to this child’s adoption; or
(d) any negotiations or arrangements leading up to this child’s adoption,
except for what is permitted by the Child and Family Services Act and the regulations made under that Act.
9.
I/We understand the importance of the child's culture and will make efforts to preserve his/her traditions, heritage and
cultural identity.
10. I/We understand that once the child turns eighteen years old, he/she can apply for a copy of his/her original birth
registration, if any, and a copy of his/her adoption order.
11. I/We understand that once the child turns nineteen years old, his/her birth parent(s) can apply for information from his/her
original birth registration, if any, any substituted birth registration, and his/her adoption order. This information would include
the child's full legal name after adoption.
12. I/We understand the provisions of the Vital Statistics Act and the Child and Family Services Act related to the disclosure of
adoption information
13. I/We want to bring to the court’s attention the following additional facts about the child’s best interests:
(Give any additional
facts. If you need more space, you may add a page.)
Put a line through any blank space left on this page
Sworn/Affirmed before me at
municipality
in
Signature
province, state or country
(This form is to be signed in front of a
on
lawyer, justice of the peace, notary public or
Commissioner for taking affidavits
date
commissioner for taking affidavits.)
(Type or print name below if signature is illegible.)
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FLR-34D-E (2009/04)
Page 3 of 3
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