Child'S Consent To Secure Treatment Page 2

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Form 33E: Child’s Consent to Secure Treatment
(page 2)
Court File Number
AFFIDAVIT OF EXECUTION AND INDEPENDENT LEGAL ADVICE
My name is
(full legal name)
and I swear/affirm that the following is true:
1. I am a member of the Bar of
(name of jurisdiction)
and am not acting for any other person in this secure treatment case.
2. I explained to
(child’s full legal name)
the nature and effect of
secure treatment;
an extension of secure treatment;
release from secure treatment;
the consequences of not attending the hearing; and
the consequences of a hearing where a court proceeds without hearing oral evidence;
in language appropriate to his/her age to the best of my knowledge and skills.
3. After my explanation, the child told me that he/she wanted to sign this consent.
4. I was present at and witnessed the signing of this consent by the child.
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
date
Commissioner for taking affidavits
or commissioner for taking affidavits.)
(Type or print name below if signature is illegible.)
Save Form
Print Form
Clear Form
FLR-33E-E (2005/09)
Page 2 of 2

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