Form 33E "Child's Consent to Secure Treatment" - Ontario, Canada

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Download Form 33E "Child's Consent to Secure Treatment" - Ontario, Canada

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ONTARIO
Court File Number
(Name of Court)
Form 33E: Child’s
at
Consent to Secure
Court office address
Treatment
Applicant(s)
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
Lawyer’s name & address — street & number, municipality, postal
Full legal name of child:
code, telephone & fax numbers and e-mail address (if any).
Birthdate:
Sex:
1. My name is
(child’s full legal name)
2. I know that the applicant(s) is/are asking the court to make an order
to send me to and maybe have me locked up for my own protection at
to keep me for a longer time and maybe keep me locked up for my own protection at
to get me released from
(name and address of program)
3. I know that
I have a right to be in court when this case is heard by the judge, but I agree not to come to court and to let
the court make whatever order needs to be made without me.
the court usually needs to hear witnesses before it can make an order in this case, but I agree that the court
can make the order without having to hear witnesses in person and can reach its decision on evidence found
in the reports and other documents that the applicant(s) can show to the judge.
4. I have talked with a lawyer
(a)
who has explained these things to me, and
(b)
who has explained what it means for me to sign this consent, and
(c)
who is going to witness my signature of this form.
signature of child
Date of signature
NOTE: This consent must be witnessed by an independent lawyer who is
to provide an affidavit of independent legal advice on page 2 of this form.
signature of lawyer
NOTE: A consent to dispense with oral evidence is not effective for more
than 180 days after the court’s order.
FLR-33E-E (2005/09)
Page 1 of 2
ONTARIO
Court File Number
(Name of Court)
Form 33E: Child’s
at
Consent to Secure
Court office address
Treatment
Applicant(s)
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
Lawyer’s name & address — street & number, municipality, postal
Full legal name of child:
code, telephone & fax numbers and e-mail address (if any).
Birthdate:
Sex:
1. My name is
(child’s full legal name)
2. I know that the applicant(s) is/are asking the court to make an order
to send me to and maybe have me locked up for my own protection at
to keep me for a longer time and maybe keep me locked up for my own protection at
to get me released from
(name and address of program)
3. I know that
I have a right to be in court when this case is heard by the judge, but I agree not to come to court and to let
the court make whatever order needs to be made without me.
the court usually needs to hear witnesses before it can make an order in this case, but I agree that the court
can make the order without having to hear witnesses in person and can reach its decision on evidence found
in the reports and other documents that the applicant(s) can show to the judge.
4. I have talked with a lawyer
(a)
who has explained these things to me, and
(b)
who has explained what it means for me to sign this consent, and
(c)
who is going to witness my signature of this form.
signature of child
Date of signature
NOTE: This consent must be witnessed by an independent lawyer who is
to provide an affidavit of independent legal advice on page 2 of this form.
signature of lawyer
NOTE: A consent to dispense with oral evidence is not effective for more
than 180 days after the court’s order.
FLR-33E-E (2005/09)
Page 1 of 2
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.)
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FLR-33E-E (2005/09)
Page 2 of 2
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