Fillable Application Child Protection And Status Review (Page 3 of 7) in pdf

Form 8B:

Application (Child Protection

(page 3)

Court file number

and Status Review)

THE CHILD(REN):

(List all children involved in this case.)

Child's Full Legal

Full Legal Name

Child's

Child's Native

Birthdate

Age

Sex

Name

of Mother

of Father

Religion

Status

CLAIM BY APPLICANT

NOTE: If this case is an application for a status review, strike out paragraph 1 and go immediately to paragraph 2.

1. The applicant children’s aid society asks the court to make a finding under Part III of the Child and Family Services Act that

the child(ren) named in this application is/are in need of protection because:

(Check the applicable box(es). In each checked paragraph, delete those portions of the text that are not relevant.)

the child(ren) has/have suffered physical harm, inflicted by the person having charge of the child(ren) or caused by that

person’s

failure to care for, provide for, supervise or protect the child(ren) adequately [subclause 37(2)(a)(i)].

pattern of neglect in caring for, providing for, supervising or protecting the child(ren) [subclause 37(2)(a)(ii)].

there is a risk that the child(ren) is/are likely to suffer physical harm inflicted by the person having charge of the child(ren)

or caused by that person’s

failure to care for, provide for, supervise or protect the child(ren) adequately [subclause 37(2)(b)(i)].

pattern of neglect in caring for, providing for, supervising or protecting the child(ren) [subclause 37(2)(b)(ii)].

the child(ren) has/have been sexually molested or sexually exploited, by the person having charge of the child(ren) or by

another person where the person having charge knows or should know of the possibility of sexual molestation or sexual

exploitation and fails to protect the child(ren) [clause 37(2)(c)].

there is a risk that the child(ren) is/are likely to be sexually molested or sexually exploited, by the person having charge of

the child(ren) or by another person where the person having charge knows of should know of the possibility of sexual

molestation or sexual exploitation and fails to protect the child(ren) [clause 37(2)(d)].

the child(ren) require(s) medical treatment to cure, prevent or alleviate physical harm or suffering and the child(ren)’s

parent or the person having charge of the child(ren) does not provide, or refuses or is unavailable or unable to consent to,

the treatment [clause 37(2)(e)].

the child(ren) has/have suffered emotional harm, demonstrated by serious anxiety, depression, withdrawal, self-destructive

or aggressive behaviour, or delayed development and there are reasonable grounds to believe that the emotional harm

suffered by the child(ren) results from the actions, failure to act or pattern of neglect on the part of the child(ren)’s parent or

the person having charge of the child(ren) [clause 37(2)(f)].

the child(ren) has/have suffered emotional harm, demonstrated by serious anxiety, depression, withdrawal, self-destructive

or aggressive behaviour, or delayed development and the child(ren)’s parent or the person having charge of the child(ren)

does not provide, or refuses or is unavailable or unable to consent to, services or treatment to remedy or alleviate the

harm [clause 37(2)(f.1)].

there is a risk that the child(ren) is/are likely to suffer emotional harm, demonstrated by serious anxiety, depression,

withdrawal, self-destructive or aggressive behaviour, or delayed development resulting from the actions, failure to act or

pattern of neglect on the part of the child(ren)’s parent or the person having charge of the child(ren) [clause 37(2)(g)].

there is a risk that the child(ren) is/are likely to suffer emotional harm, demonstrated by serious anxiety, depression,

withdrawal, self-destructive or aggressive behaviour, or delayed development and that the child(ren)’s parent or the person

having charge of the child(ren) does not provide, or refuses or is unavailable or unable to consent to services or treatment

to prevent the harm [clause 37(2)(g.1)].

FLR-8B-E (2006/10)

Page 3 of 7

Application Child Protection And Status Review Page 3

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