ONTARIO
Court File Number
(Name of Court)
Form 34C: Director’s or Local
at
Director’s Statement on
Court office address
Adoption
Applicant(s)
(The first letter of the applicant’s surname may be used)
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
(Child’s full legal name. If this person is a Crown ward or was placed by a licensee or children’s aid society, you may use an initial for
the surname.)
Date of birth
Sex
Birth registration number
A local director of a children’s aid society may complete this form only where the child was placed for adoption by the society and the child has
resided in the home of the applicant(s) for at least 6 months.
1. My name is
and I am
(full legal name)
appointed as a Director under the Child and Family Services Act.
the local director of
(full legal name of children’s aid society)
2.
The child in this adoption case
is less than 16 years of age.
is 16 years of age or more but has not withdrawn from parental control.
3.
The child has resided in the home of the applicant(s) since
(date)
4.
Having regard to the child’s best interests, I recommend:
that the period of residence be dispensed with and that an order be made for the child’s adoption by the
applicant(s).
that the court make an order of temporary custody of the child in favour of the applicant(s) for a period not
exceeding one year on the terms set out on the next sheet of this form.
because the child has resided in the home of the applicant(s) for at least 6 months, that an order be made for the
child’s adoption by the applicant(s).
that an order for the child’s adoption not be made for reasons set out on the next sheet of this form.
5.
The report on the child’s adjustment in the home of the applicant(s) is attached to this form.
6.
There are
no additional circumstances to which I want to draw the court’s attention.
additional circumstances set out on the next sheet of this form to which I want to draw the court’s
attention.
Date of signature
Signature
NOTE TO THE APPLICANT(S): If you disagree with any of the statements made in this document, you will have a chance to
challenge it in court and to present your own evidence.
NOTE TO DIRECTOR OR LOCAL DIRECTOR: If, in the Director’s or local director’s opinion, it would not be in the child’s best
interest to make the order, this form and any attachments must be filed with the court and served on the applicant(s) at least 30
days before the adoption hearing.
FLR-34C-E (2005/09)
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