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General consent memorandum relating to children

The purpose of this form: Use this form if you and the other person(s) involved have reached agreement about a matter involving children within the Family Court and you want the court to make a consented Order.

Please note: This memorandum cannot be used to commence proceedings in the Family Court. It must be used where there is an existing application or to accompany an application that is being filed in the Family Court.

Who should fill in this form: This memorandum should be completed jointly – that is, by you and all other ‘interested person(s)’ involved in your case, or by your lawyers if you are represented.

Important information: The Judge who reads this application must be satisfied that the Order(s) will be in the welfare and best interests of the child(ren) involved and that they have had an opportunity to be heard where appropriate. If the Judge is not satisfied that they can make the Order on this or any other basis they may request further information or appoint a lawyer to represent the child(ren). Please note that this might incur additional costs.

If a Lawyer for Child has already been appointed in the proceedings, you must ensure that they agree to the consented Order(s) being sought by providing their signature in the space provided under Part 4 of this form.

Filling in the forms: You will have already decided if you are filling in your forms on a computer or by hand. If you are filling in the forms by hand:

They must be clearly written.

Filled out in a BLUE or BLACK ballpoint pen.

Written in printed letters only.

Put a line through mistakes like this ABC. If you cross anything out, please write your initials in the right-hand margin to show it was done by you. Do not use correction fluid or tape.

How to file this memorandum: Each page should be printed on one side of the paper only.

The original (with the original signatures) must be filed with the Court.

You must attach any other relevant documentation to this form when filing it.

If a lawyer for the child(ren) has been appointed you must provide them a copy.

You must keep a copy for yourself.

File your documents at the Family Court where your case is being heard, by post or courier, or by taking them to the counter.

Fees/waivers: There is no fee to pay when filing this form. However fees may apply to other applications filed in the Family Court.

More information: If you need any more information or help please visit the Family Justice website www.justice.govt.nz/family-justice, visit your local Family Court or call 0800 COURTS (0800 268787). You may also be entitled to legal assistance from a family lawyer.

Please Note: You must complete all parts of this form or it may not be accepted by the Court.

1

General consent memorandum relating to children

FAM Number(s):

The Family Court where you are filing this:

In the matter of: (as listed on the application)

Applicant(s): Full name(s) Respondent(s): Full names(s)

v

The following Order(s) are to be made by consent:

The Child(ren) the consented Orders are about: Full name Age DOB(ddmmyyyyy) Gender Currently living with: (party name)

Document filed by:

For Registry use only: Date stamp

Type of Order: What you want the Court to do with this Order

2

Part 2 Agreement Details

Please provide the requested details below:

What you want the order(s) to say.

[1] _________________________________________________________________________

[2] _________________________________________________________________________

[3] _________________________________________________________________________

[4] _________________________________________________________________________

[5] _________________________________________________________________________

[6] _________________________________________________________________________

[7] _________________________________________________________________________

[8] _________________________________________________________________________

[9] _________________________________________________________________________

[10] ________________________________________________________________________

[11] ________________________________________________________________________

[12] ________________________________________________________________________

[13] ________________________________________________________________________

[14] ________________________________________________________________________

[15] ________________________________________________________________________

[16] ________________________________________________________________________

[17] ________________________________________________________________________

[18] ________________________________________________________________________

[19] ________________________________________________________________________

[20] ________________________________________________________________________

[21] ________________________________________________________________________

[22] ________________________________________________________________________

[23] ________________________________________________________________________

[24] ________________________________________________________________________

[25] ________________________________________________________________________

[26] ________________________________________________________________________

[27] ________________________________________________________________________

[28] ________________________________________________________________________

[29] ________________________________________________________________________

[30] ________________________________________________________________________

[31] ________________________________________________________________________

[32] ________________________________________________________________________

[33] ________________________________________________________________________

[34] ________________________________________________________________________

[35] ________________________________________________________________________

3 [36] ________________________________________________________________________

[37] ________________________________________________________________________

[38] ________________________________________________________________________

[39] ________________________________________________________________________

[40] ________________________________________________________________________

[41] ________________________________________________________________________

[42] ________________________________________________________________________

[43] ________________________________________________________________________

[44] ________________________________________________________________________

[45] ________________________________________________________________________

[46] ________________________________________________________________________

[47] ________________________________________________________________________

[48] ________________________________________________________________________

[49] ________________________________________________________________________

[50] ________________________________________________________________________

[51] ________________________________________________________________________

[52] ________________________________________________________________________

[53] ________________________________________________________________________

[54] ________________________________________________________________________

[55] ________________________________________________________________________

[56] ________________________________________________________________________

[57] ________________________________________________________________________

[58] ________________________________________________________________________

[59] ________________________________________________________________________

[60] ________________________________________________________________________

[61] ________________________________________________________________________

[62] ________________________________________________________________________

[63] ________________________________________________________________________

[64] ________________________________________________________________________

[65] ________________________________________________________________________

[66] ________________________________________________________________________

[67] ________________________________________________________________________

[68] ________________________________________________________________________

[69] ________________________________________________________________________

[70] ________________________________________________________________________

[71] ________________________________________________________________________

[72] ________________________________________________________________________

[73] ________________________________________________________________________

4

Part 3 Interests of the child(ren)

Check the box to show that you have given these details below:

All details of why the Order(s)will be in the welfare and best interests of the child(ren).

All details of any views the child(ren) have expressed about the proposed arrangements.

[74] ________________________________________________________________________

[75] ________________________________________________________________________

[76] ________________________________________________________________________

[77] ________________________________________________________________________

[78] ________________________________________________________________________

[79] ________________________________________________________________________

[80] ________________________________________________________________________

[81] ________________________________________________________________________

[82] ________________________________________________________________________

[83] ________________________________________________________________________

[84] ________________________________________________________________________

[85] ________________________________________________________________________

[86] ________________________________________________________________________

[87] ________________________________________________________________________

[88] ________________________________________________________________________

[89] ________________________________________________________________________

[90] ________________________________________________________________________

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[92] ________________________________________________________________________

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[94] ________________________________________________________________________

[95] ________________________________________________________________________

[96] ________________________________________________________________________

[97] ________________________________________________________________________

[98] ________________________________________________________________________

[99] ________________________________________________________________________

[100] _______________________________________________________________________

[101] _______________________________________________________________________

[102] _______________________________________________________________________

[103] _______________________________________________________________________

[104] _______________________________________________________________________

[105] _______________________________________________________________________

[106] _______________________________________________________________________

5

Part 4 Information about the agreement

Check the box to show that you have given these details below:

The details of how you have reached your agreement (such as privately, through a lawyer or court event etc).

All details of any legal advice received by the parties, or if not, the reasons why no legal advice was sought.

[107] _______________________________________________________________________

[108] _______________________________________________________________________

[109] _______________________________________________________________________

[110] _______________________________________________________________________

[111] _______________________________________________________________________

[112] _______________________________________________________________________

[113] _______________________________________________________________________

[114] _______________________________________________________________________

[115] _______________________________________________________________________

[116] _______________________________________________________________________

[117] _______________________________________________________________________

[118] _______________________________________________________________________

[119] _______________________________________________________________________

[120] _______________________________________________________________________

[121] _______________________________________________________________________

[122] _______________________________________________________________________

[123] _______________________________________________________________________

[124] _______________________________________________________________________

[125] _______________________________________________________________________

[126] _______________________________________________________________________

[127] _______________________________________________________________________

[128] _______________________________________________________________________

[129] _______________________________________________________________________

[130] _______________________________________________________________________

[131] _______________________________________________________________________

[132] _______________________________________________________________________

[133] _______________________________________________________________________

[134] _______________________________________________________________________

[135] _______________________________________________________________________

[136] _______________________________________________________________________

[137] _______________________________________________________________________

[138] _______________________________________________________________________

[139] _______________________________________________________________________

6

Part 5 Safety

Check the boxes to show you have given the details in the ‘supporting information’ section below:

If any party and/or any household member (including partners of any party) pose a risk to the child(ren) or have violence, sexual and drug or alcohol related convictions. You must give specific detail of any risk and/or convictions and by whom.

If anyone has used domestic violence or abuse against any parties including any child(ren) or household members. Please give specific details of the abuse and any Protection Orders and/or Police Safety Orders made.

If any party or child in this application is or has been involved with Child Youth and Family or any other social welfare agency. You must give specific details about who was involved and the nature of the involvement.

Supporting information: Outline the details and the reasons here:

[140] _______________________________________________________________________

[141] _______________________________________________________________________

[142] _______________________________________________________________________

[143] _______________________________________________________________________

[144] _______________________________________________________________________

[145] _______________________________________________________________________

[146] _______________________________________________________________________

[147] _______________________________________________________________________

[148] _______________________________________________________________________

[149] _______________________________________________________________________

[150] _______________________________________________________________________

[151] _______________________________________________________________________

[152] _______________________________________________________________________

[153] _______________________________________________________________________

[154] _______________________________________________________________________

[155] _______________________________________________________________________

[156] _______________________________________________________________________

[157] _______________________________________________________________________

[158] _______________________________________________________________________

[159] _______________________________________________________________________

[160] _______________________________________________________________________

[161] _______________________________________________________________________

[162] _______________________________________________________________________

[163] _______________________________________________________________________

[164] _______________________________________________________________________

[165] _______________________________________________________________________

7

Part 6 Sign and Date

Check the box to confirm the following statement:

I/we believe that all of the information that has been given in this consent memorandum is complete and accurate.

Applicant(s)

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

8 Respondent(s)

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Signed: Date:

Full name:

Your relationship to the child(ren): Parent Legal guardian Other: specify:

Signed by witness: Date:

Witness’s full name:

Lawyer Deputy Registrar Notary Public Justice of the Peace Other: specify:

Lawyer for child(ren) signature (if applicable):

Signed: Date:

Full name: