Form F102 "Consent for Child Protection Record Check" - British Columbia, Canada

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CONSENT FOR CHILD PROTECTION RECORD CHECK
NOTE: This form must be completed by any person applying for guardianship of one or more children,
and must be provided to the court registry at which the materials in support of that guardianship affidavit
have been filed.
SECTION 1
IDENTIFICATION OF PERSON SEEKING CHILD PROTECTION RECORD CHECK
First Name:
Middle Name:
Last Name/Family Name:
Other names used (include maiden name):
Address:
City:
Province:
Postal Code:
Phone No.:
Date of Birth:
Gender:
Male
Female
Primary ID (Type and No.):
Second ID (Type and No.):
SECTION 2
CHILD PROTECTION RECORD CHECK
A Child Protection Record Check (CPRC) is a report prepared for the purpose of identifying past and present
child protection concerns, if any, under the Child Family and Community Service Act (CFCSA) or its predecessor,
the Family, Child Service Act (FCSA), respecting an applicant for guardianship of a child (the "applicant") under
the Family Law Act (FLA). A CPRC is prepared by a child welfare worker at the Ministry of Children and Family
Development (MCFD) Provincial Office After Hours department. The CPRC includes a search of records
respecting the applicant collected under the FCSA and the CFCSA. The search pertains only to the applicant as
an adult and does not include records dating back to when the applicant was a child. A CPRC only documents
child protection reports that required an investigation or a family assessment and does not include services that
may have been provided to the applicant under the CFCSA or FCSA on a voluntary basis.
[Check whichever of the following statements is correct and provide any required information.]
I have not been involved at any time in the past, as an adult or parent, with child protection services.
I have been involved in the past, as an adult or as a parent, with child protection services, with my first
involvement occurring in
F102
Page 1 of 3
CONSENT FOR CHILD PROTECTION RECORD CHECK
NOTE: This form must be completed by any person applying for guardianship of one or more children,
and must be provided to the court registry at which the materials in support of that guardianship affidavit
have been filed.
SECTION 1
IDENTIFICATION OF PERSON SEEKING CHILD PROTECTION RECORD CHECK
First Name:
Middle Name:
Last Name/Family Name:
Other names used (include maiden name):
Address:
City:
Province:
Postal Code:
Phone No.:
Date of Birth:
Gender:
Male
Female
Primary ID (Type and No.):
Second ID (Type and No.):
SECTION 2
CHILD PROTECTION RECORD CHECK
A Child Protection Record Check (CPRC) is a report prepared for the purpose of identifying past and present
child protection concerns, if any, under the Child Family and Community Service Act (CFCSA) or its predecessor,
the Family, Child Service Act (FCSA), respecting an applicant for guardianship of a child (the "applicant") under
the Family Law Act (FLA). A CPRC is prepared by a child welfare worker at the Ministry of Children and Family
Development (MCFD) Provincial Office After Hours department. The CPRC includes a search of records
respecting the applicant collected under the FCSA and the CFCSA. The search pertains only to the applicant as
an adult and does not include records dating back to when the applicant was a child. A CPRC only documents
child protection reports that required an investigation or a family assessment and does not include services that
may have been provided to the applicant under the CFCSA or FCSA on a voluntary basis.
[Check whichever of the following statements is correct and provide any required information.]
I have not been involved at any time in the past, as an adult or parent, with child protection services.
I have been involved in the past, as an adult or as a parent, with child protection services, with my first
involvement occurring in
F102
Page 1 of 3
SECTION 3
REASON FOR REQUESTING A CPRC
Section 51(2) of the FLA requires an applicant to provide evidence, in accordance with the Supreme Court Family
Rules or the Provincial Court (Family) Rules, respecting the best interests of the child. An applicant must submit a
CPRC to the court to assist the court in determining the best interests of the child.
I am applying in the
Registry of the
Supreme Court
Provincial Court
under Action No.
for the guardianship of:
[Complete one line for each child for which guardianship is sought. Add additional lines if required]
Child's place of residence
Name of child
Child's date of birth
[Check the correct box.]
this child currently resides with me
this child does not currently reside with me
but will be coming to live with me
this child currently resides with me
this child does not currently reside with me
but will be coming to live with me
this child currently resides with me
this child does not currently reside with me
but will be coming to live with me
SECTION 4
POSSIBLE CONSEQUENCES OF A CPRC
A CPRC may result in any of the following:
1.
If a CPRC indicates that there is reason to believe that a child who is currently in, or about to come into, the
applicant's care may need protection under section 13 of the CFCSA, the child welfare worker conducting
the CPRC will make a report to a local child welfare worker for further assessment under the CFCSA.
2.
If a CPRC indicates that the applicant currently has an open child protection file, the delegated child welfare
worker conducting the CPRC will notify the child welfare worker with conduct of the open file that the
applicant is seeking guardianship under the FLA.
3.
In response to a CPRC, a judge may order that more CFCSA or FCSA records be provided to the court.
4.
In response to a CPRC, a judge may order an assessment of the applicant's ability and willingness to
satisfy the needs of the child under section 211 of the FLA.
5.
The director of the CFCSA may apply for leave to intervene in the guardianship proceedings under the FLA
if the Director considers it in the best interest of the child to do so.
F102
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SECTION 5
CONSENT
I have read and completed section 1 to 4 and understand what a CPRC will entail, why a CPRC is required for my
guardianship application and the possible consequences of a CPRC. I consent to a child welfare worker from
MCFD conducting and completing a CPRC for me to submit to the court as evidence in my guardianship
application. This consent is valid for 1 year from the date of signature.
Date
Signature
[The applicant signing this consent must also swear the following declaration if this form is provided to the court registry by a person other
than the applicant. The applicant need not swear the following declaration if the applicant personally presents this consent to the court registry
and provides the evidence of identity required by the registry staff.]
I SWEAR (OR AFFIRM) THAT I am the person referred to in section 1 of this consent, that the information in
sections 1 and 3 of this consent is true and complete and that I have signed section 5 of this consent.
SWORN (OR AFFIRMED) BEFORE
ME at
, British Columbia
)
)
on
)
[dd/mmm/yyyy]
)
)
)
)
A commissioner for taking affidavits for
)
British Columbia
[print name or affix stamp of commissioner]
F102
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