Alberta Gazette — 31 March (ii)
0331 ii
Alberta — Gazette
Alberta Regulation 37/95
Highway Traffic Act
MAXIMUM SPEED LIMITS AMENDMENT REGULATION
Filed: March 7, 1995
Made by the Minister of Transportation and Utilities pursuant to
section 5
of the Highway Traffic Act.
1 The Maximum Speed Limits Regulation (Alta. Reg. 218/83) is amended by
this Regulation.
Schedule 1 is amended
(
a) in
section 1 by adding the following after subsection (13):
(14) Strathmore to Calgary
(
a) All that portion of Highway Number 1 beginning from
the north/south quarterline of
section 10, township 24, range 25, west of
the fourth meridian (west limit of Strathmore), thence westerly along the
highway to the northwest corner of
section 19, township 24, range 28, west
of the fourth meridian (the east limit of Calgary),
Daytime maximum - 110 kilometres per
hour;
Nighttime maximum - 100 kilometres per
hour.
(
b) in
section 19(1)(
a) by striking out "to the north/south
quarterline of
section 18, township 53, range 22," and substituting "to its
intersection with Highway Number 16A at the northwest corner of
section 9,
township 53, range 23,";
(
c) by repealing
section 53(2) and substituting the following:
(2) Athabasca
(
a) All that portion of Highway Number 55 beginning
from the north/south quarterline of
section 22, township 66, range 22, west
of the fourth meridian (east limit of Athabasca), thence westerly along the
highway to a point 200 metres east of its intersection with 43rd Street, in
the southeast quarter of
section 21, township 66, range 22, west of the
fourth meridian,
Maximum - 70 kilometres per hour.
(
d) by repealing
section 54(2) and substituting the following:
(2) High Level
(
a) East of the East Limit - All that portion of
Highway Number 58 beginning from a point 400 metres west of the southeast
corner of
section 2, township 110, range 19, west of the fifth meridian,
thence westerly along the highway to the north/south quarterline of
section
3, township 110, range 19, west of the fifth meridian (east limit of High
Level),
Maximum - 80 kilometres per hour;
(
b) East Limit - All that portion of Highway Number 58
East beginning from the north/south quarterline of
section 3, township 110,
range 19, west of the fifth meridian, thence westerly along the highway to
the north/south quarterline of
section 4, township 110, range 19, west of
the fifth meridian,
Maximum - 80 kilometres per hour;
(
c) West Limit - All that portion of Highway Number 58
West beginning from a point 700 metres west of its intersection with
Highway Number 35, in the northwest quarter of
section 32, township 109,
range 19, west of the fifth meridian, thence westerly along the highway to
the east boundary of
section 36, township 109, range 20, west of the fifth
meridian (west limit of High Level),
Maximum - 100 kilometres per hour.
Alberta Regulation 38/95
Child Welfare Act
COURT RULES AND FORMS AMENDMENT REGULATION
Filed: March 8, 1995
Made by the Lieutenant Governor in Council (O.C. 129/95) pursuant to
section 96 of the Child Welfare Act.
1 The Court Rules and Forms Regulation (Alta. Reg. 184/85) is amended by
this Regulation.
2 The
Schedule is repealed and the attached
Schedule is substituted.
3 This Regulation comes into force on March 31, 1995.
SCHEDULE
FORM 1
NOTICE AND APPLICATION TO TERMINATE
A PERMANENT GUARDIANSHIP AGREEMENT
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am this child's parent. My address is (address) .
I am a child welfare worker. I have the authority to act for a
Child Welfare Director.
Notice
This is your notice that I will be applying to the Court for an order
under the Child Welfare Act terminating the permanent guardianship
agreement regarding this child. A copy of my application is below this
notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order.
If you do not attend the court hearing, the judge may still make an
order.
Application
This child is the subject of a permanent guardianship
agreement entered . A director is the
child's only guardian.
I am applying for an order terminating the permanent guardianship
agreement regarding this child.
I am a parent of the child. I am applying for a further order:
declaring that I am a parent of the child
appointing me as a guardian of the child
directing that the child be placed in the custody of
(name of guardian)
terminating the guardianship of (name of guardian)
and the consent of the guardian is attached to this
application
I am a child welfare worker. I believe that the child should
be returned to the guardianship of the person who was the guardian of the
child before the agreement was entered.
I am applying for this order because:
(applicant's signature)
FORM 2
NOTICE AND APPLICATION
FOR A SUPERVISION ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) . I am a child welfare worker. I have
the authority to act for a Child Welfare Director.
Notice
This is your notice that I will be applying to the Court for a
supervision order under the Child Welfare Act regarding this child. A copy
of my application is below this notice. A supervision order entitles the
director to supervise the child and anyone who lives with the child.
The court hearing will be at (address) on
The judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than a supervision order.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for a supervision order regarding this child.
The child needs protective services.
To protect the child's survival, security or development, the child
and (name) who lives with the child need supervision because:
I recommend the following terms of supervision:
(applicant's signature)
FORM 3
NOTICE AND APPLICATION
FOR A TEMPORARY GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) . I am a child welfare worker. I have
the authority to act for a Child Welfare Director.
Notice
This is your notice that I will be applying to the Court for a
temporary guardianship order under the Child Welfare Act regarding this
child. A copy of my application is below this notice. A temporary
guardianship order makes the director a guardian of the child. The
director takes over responsibility for the child's care during the time of
the order.
The court hearing will be at (address) on
The judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than a temporary guardianship order. If you do not
attend the court hearing, the judge may still make an order.
Application
I am applying for a temporary guardianship order regarding this
child. The child needs protective services. To protect the child's
survival, security or development, the child cannot remain with the
guardian because:
I believe that within a reasonable time:
the child can be returned to the guardian, or
the child will be able to live without a guardian.
I am also applying for an order:
setting out the type and amount of contact the child will
have with (name)
setting out the matters the director must discuss with
(name)
requiring (name) to make payments of $
(amount) towards the child's maintenance.
I am also applying for an order requiring (name) to be
assessed to determine whether that person can properly take care of the
child if the child returns to live with that person.
(applicant's signature)
FORM 4
NOTICE AND APPLICATION FOR TERMS
OF A TEMPORARY GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am the child.
My relationship to the child is (e.g. guardian) .
My birth date is
My address is (address) .
I am a child welfare worker. I have the authority to act for a
Child Welfare Director.
Notice
This is your notice that I will be applying to the Court for an order
under the Child Welfare Act setting terms for the temporary guardianship of
this child. A copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than what I apply for. If you do not attend the
court hearing, the judge may still make an order.
Application
I am applying for terms for the temporary guardianship order
regarding
this child granted on
I am applying for an order:
setting out the type and amount of contact the child will
have with (name)
setting out the matters the director must discuss with
(name)
requiring (name) to make payments of $
(amount) towards the child's maintenance.
I am applying for an order requiring (name) to be
assessed to determine whether that person can properly take care of the
child if the child returns to live with that person.
(applicant's signature)
FORM 5
NOTICE AND APPLICATION FOR A REVIEW
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am the child.
My relationship to the child is (e.g. guardian) .
My birth date is
My address is (address) .
I am a child welfare worker. I have the authority to act for a
Child Welfare Director.
Notice
This is your notice that I will be applying to the Court for a review
under the Child Welfare Act of the (type of order) order regarding this
child. A copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than what I apply for.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for a review of the (type of order) order
regarding this child granted on for a
period of (duration).
I am applying for an order to:
renew the existing order.
vary the existing order.
terminate the existing order.
I am applying to terminate the existing order and replace it
with:
a supervision order.
a temporary guardianship order.
a permanent guardianship order.
I am applying for this review because:
(applicant's signature)
FORM 6
NOTICE AND APPLICATION BY A DIRECTOR FOR A
PERMANENT GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Notice
This is your notice that I will be applying to the Court for a
permanent guardianship order under the Child Welfare Act regarding this
child. A copy of my application is below this notice. A permanent
guardianship order makes the director the child's only guardian. The
director takes over all the child's care.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than a permanent guardianship order.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for a permanent guardianship order regarding this child
. The child needs protective services. To protect the child's survival,
security or development, the child cannot live with the guardian because:
I do not believe that the child can be returned to the guardian
within a reasonable time.
I am also applying for an order that (name) make
payments of $ (amount) towards the child's maintenance.
I am also applying for an order setting out the type and amount
of contact the child will have with (name) .
(applicant's signature)
FORM 7
NOTICE AND APPLICATION BY A GUARDIAN FOR A
PERMANENT GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
My birth date is
I am a guardian of this child. My address is (address) .
Notice
This is your notice that I will be applying to the Court for a
permanent guardianship order under the Child Welfare Act regarding this
child. A copy of my application is below this notice. A permanent
guardianship order makes the director the child's only guardian. The
director takes over all the child's care.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than a permanent guardianship order.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for a permanent guardianship order. I want to give up
this child to the director because:
(applicant's signature)
FORM 8
NOTICE AND APPLICATION FOR ACCESS
OR MAINTENANCE UNDER A
PERMANENT GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am the child.
My relationship to the child is (e.g. guardian) .
My birth date is
My address is (address) .
I am a child welfare worker. I have the authority to act for a
Child Welfare Director.
Notice
This is your notice that I will be applying to the Court for an order
under the Child Welfare Act setting terms for the permanent guardianship of
this child. A copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than what I apply for.
If you do not attend the court hearing, the judge may still make an
order.
Application
A permanent guardianship order regarding this child was
granted on
I am applying for an order:
requiring (name) to make payments of $
(amount) towards the child's maintenance.
setting out the type and amount of contact the child will have
with (name) , because:
(applicant's signature)
FORM 9
APPLICATION FOR AN APPREHENSION ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Application
I am applying for an order under
section 17 of the Child Welfare Act:
authorizing the director to apprehend this child.
authorizing the director, a child welfare worker or
(name) , and any peace officer called on to assist, to enter, by force if
necessary, the place or premises specified in my declaration below and to
search for and apprehend this child.
authorizing the director, a child welfare worker or
(name) , and any peace officer called on to assist, to enter, by force if
necessary, the place or premises specified in my declaration below and to
search for and remove this child for the purpose of returning the child to
the custody of the director.
Declaration
In support of my application, I solemnly declare:
I have reasonable and probable grounds to believe that this
child needs protective services because:
I have reasonable and probable grounds to believe that the
child may be found at (address)
This child was in the custody of the director and left or was
removed from that custody without the consent of the director. I have
reasonable and probable grounds to believe that the child may be found at
(address) and I make this solemn declaration conscientiously
believing it to be true and knowing that it is of the same force and effect
as if made under oath.
(applicant's signature)
Declared before me at (city or town) ,
in the Province of Alberta on
Notary Public or Commissioner for Oaths
FORM 10
IN THE PROVINCIAL COURT OF ALBERTA
IN THE MATTER OF ,
BORN ON , 19 ,
A CHILD WITHIN THE MEANING OF
THE CHILD WELFARE ACT
Before Honour day, the
Judge day of
at , , 19
Alberta
APPREHENSION ORDER
WHEREAS (name) , authorized by a director, has applied for an order
authorizing the apprehension of the child;
AND
WHEREAS I am satisfied that
the applicant has reasonable and probable grounds to believe
that the child is in need of protective services;
the child is in the custody of a director, has left or been
removed from that custody without the consent of the director and the
director has reasonable and probable grounds to believe that the child may
be found in a place or premises;
(Check the appropriate box.)
IT IS ORDERED THAT the director, or any person authorized by the director,
may apprehend the child forthwith;
IT IS FURTHER ORDERED THAT the director, a child welfare worker or
(name) , and any peace officer called upon to assist, may enter (place
or premises) , using force if necessary, in order to search for and
apprehend the child.
(Judge or Clerk of the Court)
FORM 11
DEMAND NOTICE FOR AN EARLY HEARING
Regarding each of the children
(name) , born
(name) , born
(name) , born
(name) , born
My name is (name) .
I am a guardian of the child.
Notice
To the director or a child welfare worker authorized to act for the
director.
This child has been apprehended.
Because I do not want to wait for up to 10 days for a hearing about
my child, I demand that a hearing be held about the child on the next
working day after you receive this notice.
You may give me a notice about the time and place of the hearing:
in writing at (address) , or
by telephone at (number(s)) .
Signature
(guardian's signature) ,
FORM 12
APPEARANCE TO SHOW CAUSE FOR CONFINEMENT
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Appearance to Show Cause
The child was apprehended on
The child was confined on
I am appearing to show cause why the confinement of the child was
necessary.
Application
I am applying under
Section 20(7) of the Child Welfare Act for
an order authorizing the confinement of this child for a further period of
not more than 6 days.
Declaration
I solemnly declare:
that this child was confined because:
that the child requires further confinement because:
and I make this solemn declaration conscientiously believing it to be
true and knowing that it is of the same force and effect as if made under
oath.
(child welfare worker's signature)
Declared before me at (city or town) ,
in the Province of Alberta on
Notary Public or Commissioner for Oaths
FORM 13
NOTICE AND APPLICATION FOR AN ORDER
RETURNING AN APPREHENDED CHILD
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Notice
This is your notice that I will be applying to the Court for an order
under the Child Welfare Act returning this child to the custody of the
guardian. A copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than an order returning the child.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for an order returning this child to the custody of the
guardian.
The child was apprehended on
I believe that the child can be returned to the guardian because:
(applicant's signature)
FORM 14
NOTICE AND APPLICATION FOR
A TREATMENT ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Notice
This is your notice that I will be applying to the Court for an order
under the Child Welfare Act authorizing treatment for this child. A copy
of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for an order authorizing (describe needed treatment)
for this child.
The child was apprehended on
The guardian refuses to consent to this treatment, which is
recommended by (name of physician or dentist) of (address)
because:
(applicant's signature)
FORM 15
NOTICE AND APPLICATION FOR A
JOINT GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
My birth date is
My address is (address) .
Notice
This is your notice that I will be applying to the Court for a joint
guardianship order under the Child Welfare Act regarding this child. A
copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
Application
I am applying for a joint guardianship order regarding this child.
The child is the subject of a:
permanent guardianship order granted on
permanent guardianship agreement made on
I am over the age of 18 years and I am capable of assuming and
willing to assume the responsibility of joint guardianship of the child.
My significant and continuing relationship with the child has been:
My appointment will be beneficial to the child because:
(applicant's signature)
FORM 16
NOTICE AND APPLICATION FOR
A SECURE TREATMENT ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Notice
This is your notice that I will be applying to the Court for a secure
treatment order under the Child Welfare Act regarding this child. A copy
of my application is below this notice. A secure treatment order
authorizes the director to confine the child in a secure treatment
institution.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order.
If you do not attend the court hearing, the judge may still make an
order.
Application
This child:
is the subject of a temporary guardianship order granted
on for a period of (duration) .
is the subject of a permanent guardianship order granted
was apprehended on
I am applying for:
a secure treatment order regarding the child.
a renewal of the first secure treatment order regarding
this child, granted on
a renewal of the secure treatment renewal order
regarding this child, granted on
I believe that the child is suffering from a mental or behavioral
disorder, that the child is in a condition presenting a danger to himself
or others and that it is necessary to confine the child in order to remedy
or alleviate the disorder because:
(applicant's signature)
FORM 17
IN THE PROVINCIAL COURT OF ALBERTA
IN THE MATTER OF ,
BORN ON , 19 ,
A CHILD WITHIN THE MEANING OF
THE CHILD WELFARE ACT
Before Honour day, the
Judge day of
at , , 19
Alberta
SECURE TREATMENT ORDER
WHEREAS (name) , authorized by a director, has applied for secure
treatment in respect of (name) ;
AND
WHEREAS I am satisfied that
the child is suffering from a mental or behavioral disorder,
the child is in a condition presenting a danger to himself or others,
and
it is necessary to confine the child in order to remedy or alleviate
the disorder;
IT IS ORDERED that the child be confined in a secure treatment institution
specified by a director for days commencing forthwith and
terminating on the day of , 19 .
(Judge or Clerk of the Court)
TAKE NOTICE THAT:
1 The reasons for the confinement are:
2 The period of confinement will be for days and will
terminate on the day of , 19 .
3 The order may be reviewed or appealed on the application of the
child, the child's guardian or a director.
4 A copy of the form prescribed for making an application for a
review may be obtained from the person in charge of the secure treatment
institution in which the child is detained.
5 The child may be represented by a lawyer at any application to
the Court.
6 The address and telephone number of the nearest office of the
Legal Aid Society of Alberta is .
(Judge or Clerk of the Court)
To: Clerk of the Court
Guardian(
s) A director
Child (12 years of age of over)
Child's lawyer (if applicable)
FORM 18
APPLICATION FOR AN ORDER TO ENTER,
SEARCH FOR, APPREHEND AND RETURN A CHILD
TO SECURE TREATMENT
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Application
I am applying for an order under
section 46 of the Child Welfare Act
authorizing the director, a child welfare worker or (name) , and any peace
officer called on to assist, to enter, by force if necessary, the place or
premises specified in my declaration below and to search for, apprehend and
convey this child to any secure treatment institution and to detain the
child while he is being conveyed to a secure treatment institution.
Declaration
In support of my application, I solemnly declare:
This child is the subject of a secure treatment certificate
that expires
This child is the subject of a secure treatment order
that expires
The child has left a secure treatment institution:
when a leave of absence had not been granted.
pursuant to a leave of absence but has not returned
within the time prescribed.
I have reasonable and probable grounds to believe that the child may
be found at (address)
I make this solemn declaration conscientiously believing it to be
true and knowing that it is of the same force and effect as if made under
oath.
(applicant's signature)
Declared before me at (city or town) ,
in the Province of Alberta on
Notary Public or Commissioner for Oaths
FORM 19
IN THE PROVINCIAL COURT OF ALBERTA
IN THE MATTER OF ,
BORN ON , 19 ,
A CHILD WITHIN THE MEANING OF
THE CHILD WELFARE ACT
Before Honour day, the
Judge day of
at , , 19
Alberta
ORDER TO ENTER PREMISES, SEARCH
FOR, APPREHEND AND RETURN CHILD
TO SECURE TREATMENT
WHEREAS (name) , authorized by a director has applied for an order
authorizing the entry by force if necessary of any place or premises, to
search for, apprehend and convey the child to any secure treatment
institution and to detain the child while he is being conveyed to a secure
treatment institution.
AND
WHEREAS I am satisfied that:
the child has left the secure treatment institution without a
leave of absence;
(or)
the child has not returned to the secure treatment institution
within the time prescribed.
AND
WHEREAS I am satisfied that the child may be found at:
AND
WHEREAS I am satisfied that it may be necessary to use force to enter
the above premises.
IT IS ORDERED THAT the director, a child welfare worker
or (name) , and any peace officer called upon to assist, may enter,
using force if necessary, (place or premises) to search for,
apprehend and convey the child to any secure treatment institution and to
detain the child while he is being conveyed to a secure treatment
institution.
(Judge or Justice of the Peace)
FORM 20
NOTICE AND APPLICATION FOR A PRIVATE
GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding each of the children
(name) , born
(name) , born
(name) , born
(name) , born
My name is (name) . My birth date is
My address is (complete mailing address) . My telephone number is
(home phone number), (work phone number) .
My name is (name - if there is a second applicant). My
birth date is
My address is (complete mailing address) . My telephone number is
(home phone number), (work phone number) .
Notice
This is your notice that I will be applying to the Court for a
private guardianship order regarding this child. A private guardianship
order would make me a guardian of the child. A copy of my application is
below this notice.
The court hearing will be at (address) on
The judge will hear my application as soon as possible after (time)
If you want to speak to the judge about my application, you must
attend the hearing.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for a private guardianship order regarding this child.
I am not applying to make it easier for me to adopt the child.
1. The child lives or I live in Alberta, or
I am applying to waive the requirement that one
of us must live in Alberta.
2. I have had continuous care of the child since about
, or
I am applying to waive the requirement that I must
have continuous care of the child for more than 6
months.
3. The child is not the subject of a temporary guardianship order.
4. The consent of each guardian is attached to this
application, or
I am applying to dispense with the consent of
(name of guardian) .
5. (If the child is 12 years old or over):
The consent of the child is attached to this
application, or
I am applying to dispense with the consent of
the child.
6. I am able and willing to assume guardianship of the child. I
believe my guardianship would be in the child's best interests because:
7. I am also applying for an order terminating the
guardianship of (name of guardian) because:
(applicant's
signature)
(second applicant's
signature)
FORM 21
NOTICE AND APPLICATION BY A DIRECTOR
FOR A PRIVATE GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
Notice
This is your notice that I will be applying to the Court on behalf of
the applicant for a private guardianship order under the Child Welfare Act
regarding this child. A copy of my application is below this notice. A
private guardianship order makes the private guardian the child's only
guardian.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
If you do not attend the court hearing, the judge may still make an
order.
Consent of Applicant
My name is (name) . I consent to a director making this
application on my behalf for a private guardianship order.
(witness's (applicant's
signature) signature)
Application
I am applying on behalf of the applicant (name of applicant) for a
private guardianship order regarding this child.
1. The child is the subject of a permanent guardianship:
agreement entered on , or
order granted on and the appeal
period has expired.
2. The child or the applicant resides in Alberta, or
I am applying on behalf of the applicant to have the
residency requirement waived.
3. The applicant has had continuous care of the child
since about , or
I am applying on behalf of the applicant to have the
6 month continuous care requirement waived.
I believe that the applicant is able and willing to assume
guardianship of the child. I am satisfied that it is in the best interests
of the child for the child to be placed under the guardianship of the
applicant. I am satisfied that the purpose of this application is not to
make it easier for the applicant to adopt the child.
(child welfare worker's signature),
FORM 22
IN THE PROVINCIAL COURT OF ALBERTA
IN THE MATTER OF ,
BORN ON , 19 ,
A CHILD WITHIN THE MEANING OF
THE CHILD WELFARE ACT
REPORT SUPPORTING AN APPLICATION FOR
PRIVATE GUARDIANSHIP
I, , a qualified person under the Child Welfare Act,
report as follows:
PART A: APPLICANTS
Applicant's Name Applicant's Name
Birthdate Birthdate
Residence Residence
The applicant(
s) was/were interviewed on the following dates:
, in the following location(s): .
Persons other than the applicant(
s) residing in the home are (specify
legal name and relationship to applicant and, as applicable, duration and
quality of relationship, or, if no relationship, reason in the home):
Description of applicant(s) (including physical, personality,
intellectual, emotional, educational, familial, cultural, social,
religious, the relationship between applicants - nature and duration, and
source of income considerations, ensuring special factors relevant to the
proposed private guardianship of the child are highlighted):
PART B: REFERENCES
References interviewed (name, occupation, address, date, location,
relationship to applicant(
s) if any, on what basis judgment is made about
applicants' potential/actual parenting ability, and results of
interview(s)):
PART C: CHILD
Child name Birthdate
Residence (if different from applicant's) .
Description of child (including physical, personality, intellectual,
emotional, attachment to prospective guardians, educational, familial,
cultural, social and religious considerations as applicable, child's
opinion, ensuring special needs are highlighted):
PART D: RECOMMENDATION
In my opinion the applicant(
s) is/are (not) capable, willing and
suitable to assume responsibility toward the child for the following
reasons (including consideration of motivation for private guardianship,
stability of relationship, family dynamics, parenting skills/attitudes
towards parenting):
In my opinion private guardianship of the child by the applicant(
s) is (not) in the interests of the child for the following reason(s):
(name) (signature)
(qualifications) (date)
(address)
FORM 23
CONSENT BY A CHILD 12 YEARS OF AGE OR OLDER
Note: Do not use this form to consent to an adoption.
Consent
My name is (child's name) , born
My address is .
I know that (name of applicant) is applying in Court for a
(type of order) order about me.
I understand what this order means. I consent to the order.
(witness's signature) (child's signature)
Affidavit of Witness
My name is (child's name) . My address is (address) .
I make oath and say that:
1. I am satisfied that:
the child has the capability to understand and appreciate
the nature and consequences of the consent,
the child is informed about the nature and consequences
of the consent, and
the consent represents what the child wants.
2. I witnessed this child sign the consent form.
(witness's signature)
Sworn before me at (city or town) ,
in the Province of Alberta on
Notary Public or Commissioner for Oaths
FORM 24
CONSENT BY A GUARDIAN
Note: Do not use this form to consent to an adoption.
Regarding the child (name) , born
Consent
My name is (name) . My address is (address) . I am a
guardian of this child. I know that (name) is applying in
Court for a (type of order) order regarding my child.
I understand what this order means. I consent to the order.
(witness's (guardian's
signature) signature)
Affidavit of Witness
My name is (name) . My address is (address) .
I make oath and say that:
1. I am satisfied that:
the guardian has the capability to understand and
appreciate the nature and consequences of the consent,
the guardian is informed about the nature and
consequences of the consent, and
the consent represents what the guardian wants.
2. I witnessed the guardian sign the consent form.
(witness's signature)
Sworn before me at (city or town) ,
in the Province of Alberta on
Notary Public or Commissioner for Oaths
FORM 25
NOTICE AND APPLICATION
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) .
I am the child.
My relationship to the child is (e.g. guardian) .
My birth date is
My address is (address) .
Notice
This is your notice that I will be applying to the Court under the
Child Welfare Act for a (type of order) order regarding this child. A
copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than what I apply for.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for a (type of order) order regarding this child
because:
(applicant's signature) (date)
FORM 26
NOTICE AND APPLICATION TO TERMINATE
A PRIVATE GUARDIANSHIP ORDER
In the Provincial Court of Alberta
In the Matter of the Child Welfare Act
Regarding the child (name) , born
My name is (name) . My address is (address) .
I am a guardian of this child.
Notice
This is your notice that I will be applying to the Court for an order
under the Child Welfare Act terminating the private guardianship order
regarding this child. A copy of my application is below this notice.
The court hearing will be at (address) on
A judge will hear my application as soon as possible after (time).
If you want to speak to the judge about my application, you must attend the
hearing.
At the end of the hearing, the judge may make an order. The judge
may make an order other than what I apply for.
If you do not attend the court hearing, the judge may still make an
order.
Application
I am applying for an order terminating the private guardianship order
regarding this child that was granted on
The private guardianship order named (name)
as a guardian of the child.
My guardianship of the child was not terminated by the private
guardianship order. I am capable of resuming and willing to resume the
responsibilities of guardianship of the child. I believe it is in the best
interests of the child to terminate the private guardianship because:
(applicant's signature) (date)
FORM 27
IN THE PROVINCIAL COURT OF ALBERTA
IN THE MATTER OF ,
BORN ON , 19 ,
A CHILD WITHIN THE MEANING OF
THE CHILD WELFARE ACT
Before Honour day, the
Judge day of
at , , 19
Alberta
CONFINEMENT ORDER
WHEREAS (name) , authorized by a director, has applied for an order
authorizing the further confinement of (name) ;
AND
WHEREAS I am satisfied that the further confinement of the child is
necessary in order to protect the survival, security or development of the
child;
IT IS ORDERED that a director may confine the child in a secure treatment
institution specified by the director for a further period of not more than
6 days, commencing forthwith.
(Judge or Clerk of the Court)
FORM 28
CONSENT BY A CHILD TO ADOPTION
Note: Use this form when adopting a child placed directly by the parent or
by a licensed agency.
In the Court of Queen's Bench of Alberta
Judicial District of
In the Matter of the Child Welfare Act
Regarding the child (name as on birth document) ,
born
Consent
My name is . My address is (full mailing
address). I know that (names of adopting parents) of (full mailing
address) are petitioning the Court for an adoption order about me. A child
welfare worker has explained to me what an adoption order means. I consent
to the adoption order. I also consent to have my name changed to
(names) .
(witness's signature) (child's signature)
Affidavit of Execution of a Director
My name is (child welfare worker's name) .
My address is (district office address) .
I make oath and say that:
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
1. I am satisfied that:
the child has the capability to understand and appreciate
the nature and consequences of the consent,
the child is informed about the nature and consequences
of the consent, and
the consent represents what the child wants.
2. I witnessed this child sign the consent form.
(signature of child welfare worker)
Sworn before me at (city or town) ,
in the Province of Alberta on
FORM 29
CONSENT BY A CHILD TO ADOPTION
Note: Use this form when adopting a child of a spouse, a child of a
relative or a child under permanent guardianship.
In the Court of Queen's Bench of Alberta
Judicial District of
In the Matter of the Child Welfare Act
Regarding the child (name as on birth document) ,
born
Consent
My name is .
My address is (full mailing address) .
I know that (names of adopting parents) of
(full mailing address) are petitioning the Court for an adoption order
about me.
1. I understand what an adoption order means.
2. I consent to the adoption order.
3. I also consent to have my name changed to
(witness's signature) (child's signature)
Affidavit of Execution
My name is (name of witness) .
My address is (address) .
I make oath and say that: I witnessed this child sign the consent
form.
(witness's signature)
Sworn before me at (city or town) ,
in the Province of Alberta on
FORM 30
CONSENT BY A GUARDIAN TO ADOPTION
Note: Use this form when adopting a child placed directly by the parent or
by a licensed adoption agency.
In the Court of Queen's Bench of Alberta
Judicial District of
In the Matter of the Child Welfare Act
Regarding the child (name as on birth document) ,
born
Consent
My name is .
My address is (full mailing address) .
I know that (names of adopting parents) of
(full mailing address) are petitioning the Court for an
adoption order regarding my child. A child welfare worker has
explained to me what an aoption order means. I understand that the order
will end all my rights and responsibilities regarding the child. I consent
to the adoption order. I understand that I may cancel this consent within
10 days by giving a written notice to a child welfare worker.
I am a guardian of this child. I understand that once I sign
this consent the petitioners become joint guardians of my child with me.
I was a guardian before the petitioner became the sole guardian
of the child.
I want to be notified of the adoption hearing.
I do not want to be notified of the adoption hearing.
(witness's (guardian's
signature) signature)
Affidavit of Execution of a Director
My name is (child welfare worker's name) .
My address is (district office address) .
I make oath and say that:
I am a child welfare worker. I have the authority to act for a Child
Welfare Director.
1. I am satisfied that:
the guardian has the capability to understand and
appreciate the nature and consequences of the consent,
the guardian is informed about the nature and
consequences of the consent, and
the consent represents what the guardian wants.
2. I witnessed the guardian sign the consent form.
(signature of child welfare worker)
Sworn before me at (city or town) ,
in the Province of Alberta on
FORM 31
CONSENT BY A GUARDIAN TO ADOPTION
Note: Use this form when adopting a child of a spouse, a child of a
relative or a child under permanent guardianship.
In the Court of Queen's Bench of Alberta
Judicial District of
In the Matter of the Child Welfare Act
Regarding the child (name as on birth document) ,
born
Consent
My name is .
My address is (full mailing address) .
I know that (names of petitioners) of
(full mailing address) are petitioning the Court for an adoption order
regarding this child.
1. I understand what an adoption order means.
2. I understand that unless I am the spouse of the petitioner, the
order will end all my rights and responsibilities regarding this child.
3. I consent to the adoption order.
4. I understand that I may cancel this consent within 10 days by
giving a written notice to a child welfare worker.
I am a guardian of this child. I understand that once I sign
this consent the petitioners become joint guardians of this child with me.
I was a guardian before the petitioner became the sole guardian
of the child.
I want to be notified of the adoption hearing.
I do not want to be notified of the adoption hearing.
(witness's (guardian's
signature) signature)
Affidavit of Execution
My name is (name of witness) .
My address is (address) .
I make oath and say that: I witnessed the guardian sign the consent
form.
(witness's signature)
Sworn before me at (city or town) ,
in the Province of Alberta on
FORM 32
PETITION
In the Court of Queen's Bench of Alberta
Judicial District of
In the Matter of the Child Welfare Act
Regarding the application by (name of petitioners) for an
adoption order regarding the child (name as on birth
document), born
Birth document number:
Petition
Names (names of petitioners) . Address (full mailing
address).
By making this petition, we state:
that we are adults who want to adopt this child.
that to support our petition, we have enclosed our
affidavits and the other information required by the Child Welfare Act.
We respectfully request that the Court order this child's adoption by
us and that the child be given the name:
Signatures
(signature of petitioner)
(signature of petitioner)
FORM 33
HOME ASSESSMENT REPORT
PART 1: APPLICANT INFORMATION (MALE)
Name: (as per birth certificate)
Birthdate:
Racial origin:
Ethnic origin:
Address:
Telephone: Residence
Business
Marital status:
Registered Indian:
Band Name:
Metis:
Metis Settlement Name
or Community:
Height: Weight: Build:
Hair Color: Eye Color: Complexion:
Personality:
Health:
Education:
Employment:
Religion:
Family history: (Include parenting style, familial relationships,
significant childhood experiences, views on adoption application)
Involvement with legal or child welfare systems:
APPLICANT INFORMATION (FEMALE)
Name: (as per birth certificate)
Birthdate:
Racial origin:
Ethnic origin:
Address:
Telephone: Residence
Business
Marital status:
Registered Indian:
Band Name:
Metis:
Metis Settlement Name
or Community:
Height: Weight: Build:
Hair Color: Eye Color: Complexion:
Personality:
Health:
Education:
Employment:
Religion:
Family history: (Include parenting style, familial relationships,
significant childhood experiences, views on adoption application)
Involvement with legal or child welfare systems:
PART 2: FAMILY DYNAMICS
Describe the following:
(
a) Marital relationship:
(
b) Family composition:
(
c) Communication patterns:
(
d) Autonomy of individual family members:
(
e) Ability to problem solve and handle crisis:
(
f) Emotional interaction:
(
g) Family traditions:
(
h) Philosophy on child rearing:
(
i) Modes of behaviour control:
(
j) Interests and hobbies:
(
k) Social support network:
PART 3: HOME AND COMMUNITY
Describe the following:
(
a) Physical space:
(
b) Availability of resources:
(
c) Community involvement:
(
d) Contact with professional agencies:
PART 4: INCOME
Describe the following:
(
a) The source and level of income and expenditures:
(
b) The effect of an adoption placement on family's
finances:
PART 5: UNDERSTANDING OF ADOPTION
AND MOTIVATION
Describe the following:
(
a) Applicant's understanding of the legal, social and
emotional aspects of adoption:
(
b) Compatibility of applicants and child desired:
(
c) Inter-racial/international adoptions, if
applicable:
(
d) Direct placements, if applicable:
PART 6: CHILD DESIRED
Age:
Sex:
Racial origin:
Legal risk placement: Yes ; No
Sibling group: Yes ; No
Acceptable background characteristics:
Acceptable special needs:
Accepting of birth family contact
birth parents Yes ; No
siblings Yes ; No
extended family Yes ; No
PART 7: REFERENCES
List 3 references' opinions regarding adoption suitability of
applicants.
PART 8: OVERVIEW OF HOME
ASSESSMENT PROCESS
Dates of personal visits.
Persons interviewed.
Activities/initiatives in support of adoption application.
PART 9:
SUMMARY OF OUTCOME
OF ASSESSMENT
PART 10: RECOMMENDATION/APPROVAL
Preparation/Review
(report prepared by) (position) (date report prepared)
(report reviewed by) (position) (date report prepared)
FORM 34
IN THE COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL DISTRICT OF
IN THE MATTER OF THE CHILD WELFARE ACT
AND IN THE MATTER OF THE APPLICATION BY
FOR AN ADOPTION ORDER IN RESPECT
OF THE CHILD
BORN ON , 19 ,
BIRTH REGISTRATION NO.
BEFORE THE HONOURABLE )
(Mr./Madame) Justice ) day, the day
) of , 19
at , Alberta )
ADOPTION ORDER
UPON the application of ;
AND UPON hearing the evidence presented;
AND UPON this honourable court being satisfied that
(
a) the applicant(
s) is/are capable of assuming and willing to
assume the responsibility of a parent toward the child, and
(
b) it is in the best interests of the child that the child be
adopted by the applicant(s).
IT IS ORDERED that the application of (name of applicant) be granted
and that the child is, from and after the date of this order, the adopted
child of the applicant(
s) and that the child shall hereafter bear the given
name(
s) and surname of .
IT IS FURTHER ORDERED
ENTERED this day of 19 .
(Clerk of the Court of Queen's Bench)
(Justice of the Court of Queen's Bench)
Alberta Regulation 39/95
Regional Airports Authorities Act
REGIONAL AIRPORTS AUTHORITIES AMENDMENT REGULATION
Filed: March 8, 1995
Made by the Lieutenant Governor in Council (O.C. 139/95) pursuant to
section 40 of the Regional Airports Authorities Act.
1 The Regional Airports Authorities Regulation (Alta. Reg. 149/90) is
amended by this Regulation.
Section 29(1) is amended by striking out "and" at the end of clause (
a) and substituting "with the first 5-year period beginning on the date on
which the authority first manages and operates an airport".
Alberta Regulation 40/95
Dairy Board Act
MINIMUM MILK PRICE ORDER
Filed: March 8, 1995
Made by the Alberta Energy and Utilities Board (Order E95022) pursuant to
section 12 of the Dairy Board Act.
1 All Class 1 milk shall be purchased on a hectolitre basis and where
that milk has a butterfat content of 3.60 kilograms per hectolitre the
minimum price for that Class 1 milk shall be $56.95 per hectolitre.
2 The Minimum Milk Price Order (Alta. Reg. 159/94) is repealed.
3 This Order comes into force March 15, 1995.
------------------------------
Alberta Regulation 41/95
Child Welfare Act
ADOPTION AMENDMENT REGULATION
Filed: March 8, 1995
Made by the Minister of Family and Social Services (M.O. 15/95) pursuant to
section 96(2) of the Child Welfare Act.
1 The Adoption Regulation (Alta. Reg. 3/89) is amended by this
Regulation.
Section 1 is amended by repealing clauses (b), (
c) and (e).
3 The following is added after
section 1:
PART 1
LICENSED ADOPTION AGENCIES
1.1 In this Part,
(a) "adoption placement" means the placement of a child
with an approved applicant for the purpose of adoption of the child by the
approved applicant;
(b) "agency" means a licensed adoption agency;
(c) "applicant", except in sections 2 and 4, means a
person who applies to an agency for an adoption placement;
(d) "direct placement" means the placement of a child
(
i) directly by the child's parent, or
(ii) with the assistance of a person
authorized by a director under
section 68.1 of the Act
in the custody of a person who intends to adopt the
child.
Section 2(2) is amended
(
a) in clause (
a) by adding "and" at the end of subclause (
i) and
repealing subclause (ii);
(
b) in clause (
b) by adding "and contract" after "staff";
(
c) in clause (
c) by repealing subclause (vi) and substituting the
following:
(vi) the processing of direct placement adoptions;
Section 4 is repealed and the following is substituted:
Inspection
4 On receiving an application for a licence to operate an agency, a
director may inspect or cause to be inspected the premises from which the
applicant proposes to operate the agency for the purpose of determining
whether the applicant will be in compliance with the Act and this
Regulation.
Section 6 is amended
(
a) in subsection (1) by striking out "on Form 2";
(
b) in subsection (2)
(
i) by repealing clause (
a) and substituting the
following:
(
a) ensure that the applicant has been
provided with a written description of the adoption services provided by
the agency and the fee
schedule for those services,
(ii) by repealing clause (b).
Section 7 is amended
(
a) in subsection (2) by striking out "Not later than 30 days
after" and substituting "After";
(
b) by repealing subsection (3).
Section 8 is repealed.
Section 9 is amended
(
a) by repealing subsection (1)(
b) and substituting the following:
(
b) require the applicant to provide a self-assessment
report on Form 4 every 12 months until the applicant receives an adoption
placement.
(
b) by adding the following after subsection (1):
(1.1) Notwithstanding subsection (1), if for any reason acceptable
to a director an agency is unable to complete a home assessment report
within the 90-day period, the director may, in writing, extend the time for
completion of the home assessment report.
(
c) by repealing subsection (2) and substituting the following:
(2) Any self-assessment report prepared in accordance with
subsection (1)(b), or any update of a home assessment report prepared at
the discretion of an agency, shall be attached to and form part of the home
assessment report.
(
d) by repealing subsection (3).
Section 10 is amended
(
a) by repealing subsection (2) and substituting the following:
(2) No approval shall be given under subsection (1)(
a) until the
applicant has received pre-placement counselling services from a qualified
person regarding the adoption process and the parenting of an adopted
child.
(
b) in subsection (5) by striking out "and the reasons for the
decision" and substituting ", the reasons for the decision and the
applicant's right to appeal the decision under
section 11".
Section 12 is amended
(
a) in subsection (1)
(
i) in clause (
a) by adding "and ensure that the
counselling services are provided by a qualified person" after "over";
(ii) by adding "and" at the end of clause (b);
(iii) by striking out "and" at the end of clause (
c) and
repealing clause (d);
(
b) by repealing subsections (2) and (3).
Section 13 is amended
(
a) by repealing subsection (2) and substituting the following:
(2) Before placing a child with an approved applicant, an agency
shall
(
a) ensure that it has obtained
(
i) a report on Form 5 prepared by a
qualified person setting out
(
A) the social history of the
child and the biological parents of the child, and
(
B) the medical history of the
biological parents of the child,
and
(ii) a medical report on Form 6 in respect
of the child prepared by a physician,
(
b) be satisfied that the child is a Canadian citizen
or has landed immigrant status, and
(
c) make every reasonable effort to obtain
(
i) a consent to adoption signed by the
guardian of the child and witnessed by a director, and
(ii) if the child is 12 years of age or
over, a consent to adoption signed by the child and witnessed by a
director.
(2.1) If, in the opinion of the program director of an agency, a
consent referred to in subsection (2)(
c) cannot reasonably be obtained
before placement of a child, the program director shall, prior to placing
the child with an approved applicant, notify a director of
(
a) the date on which the placement will be made, and
(
b) the reason why a consent cannot reasonably be
obtained before placement.
(
b) in subsection (3)
(
i) by striking out "subsection (2)(
d) and (e)" and
substituting "subsection (2)(a)(
i) and (ii)";
(ii) in clause (
b) by striking out "14" and substituting
"21";
(
c) in subsections (5) and (6) by striking out "14" and
substituting "21".
Section 14(1) is amended by striking out "14" and substituting "21".
Section 15(1)(
b) is amended by striking out "if the child is not a
resident of Canada" and substituting "unless the child is a Canadian
citizen or has been lawfully admitted to Canada for permanent residence".
Section 16 is amended
(
a) in subsection (1) by striking out "providing the agency with a
notice of termination on Form 8" and substituting "advising the agency in
writing of the termination";
(
b) by repealing subsections (2) and (3);
(
c) in subsection (4)(
a) by striking out "and of the effective date
of the termination";
(
d) by repealing subsection (5) and substituting the following:
(5) Before placing the child with an alternative approved applicant,
the agency shall, in accordance with
section 12, refer the guardian, and
the child if the child is 12 years of age or older, to a director for the
completion of a consent to adoption.
16 The following is added after
section 16:
DIRECT PLACEMENT ADOPTION
Direct placement
16.1(1) A person with whom a child has been placed for adoption
through a direct placement must apply to an agency for the processing of
the adoption.
(2) An agency must accept all applications received under subsection
(1) where the child to be adopted is a Canadian citizen or has been
lawfully admitted to Canada for permanent residence.
(3) On receiving an application under subsection (1), an agency
shall
(
a) ensure that the adopting person has been provided
with a written description of the adoption services provided by the agency
and the fee
schedule for those services,
(
b) advise the adopting person of the requirements of
section 61 of the Act,
(
c) advise the adopting person that the results of a
child welfare record check are required and provide a copy of Form 3,
(
d) advise the adopting person that the results of a
criminal record check are required, and
(
e) be satisfied that the child is a Canadian citizen
or has landed immigrant status.
(4) An agency shall ensure that the home of the adopting person is
visited by a qualified person, as soon as practicable but not later than 21
days after receiving an application under subsection (1), for the purpose
of commencing a home assessment report in respect of the adopting person.
(5) If, at any time before a petition for an adoption order is filed
with the court, the adopting person directs an agency to stop processing
the adoption, the agency shall
(
a) provide a director with written notice of that
direction,
(
b) provide or attempt to provide written notice of
that direction to the parent who placed the child with the adopting person,
and
(
c) transfer to a director all documentation in the
possession of the agency relating to the proposed adoption.
(6) If an agency receives a direction from an adopting person under
subsection (5) within 21 days after receiving that person's application
under subsection (1), subsection (4) does not apply.
(7) If, after completion of a home assessment report, an officer of
an agency decides not to recommend to the court the adoption of the child
by the person who made the application under subsection (1), the officer
shall advise that person in writing of the decision and the reasons for the
decision.
Section 17 is repealed and the following is substituted:
GENERAL
Post-placement counselling services
17(1) An agency shall provide post-placement counselling services to
the following persons, if requested by that person:
(
a) an approved applicant;
(
b) a person who has applied under
section 16.1(1) to
have a direct placement adoption processed by the agency;
(
c) an adoptive parent with whom the agency has placed
a child for adoption or for whom the agency has processed a direct
placement adoption.
(2) An agency shall provide post-placement counselling services
(
a) to a guardian who has placed a child for adoption
through the agency, or
(
b) where the agency is processing the adoption, to a
parent who has placed a child for adoption through a direct placement,
at any time after the adoption placement, for a period of up to 6
months following the granting of the adoption order, if the guardian or
parent requests those services.
(3) An agency shall ensure that post-placement counselling services
are provided by a qualified person.
Section 19 is repealed and the following is substituted:
Transfer of documents
19 On the granting of an adoption order, an agency shall transfer
to a director all copies of the documentation in the possession of the
agency that was filed with the Court in support of the petition for an
adoption order.
Section 20 is amended
(
a) by repealing subsection (1);
(
b) in subsection (2)(b)
(
i) by adding the following after subclause (vi):
(vi.1) applications to have a direct placement
adoption processed,
(vi.2) cases where a person has directed the agency
under
section 16.1(5) to stop processing a direct placement adoption,
(vi.3) cases where a child was placed with a person
for adoption through a direct placement and was subsequently removed from
the person, and the circumstances surrounding the removal,
(ii) by adding "and" at the end of subclause (vii),
striking out "and" at the end of subclause (viii) and repealing subclause
(ix);
(
c) by repealing subsection (3) and substituting the following:
(3) At the request of a director, the agency shall provide to the
director
(
a) any statistical information and reports relating to
the operation of the agency, or
(
b) copies of any documentation or other records
relating to an adoption or an adoption placement.
Section 21(4) is repealed and the following is substituted:
(4) The responsibilities of the program director include
(
a) the supervision of qualified persons delivering the
services of the agency, and
(
b) the supervision and review of home assessment
reports relating to persons who have applied to the agency for an adoption
placement and persons who have applied to the agency to have a direct
placement adoption processed, but do not include the preparation or
completion of a home assessment report.
Section 22 is repealed and the following is substituted:
Fees and expenses
22(1) An agency may charge to an applicant, a person who has applied
under
section 16.1(1) to have a direct placement adoption processed by the
agency or an adoptive parent the fees and expenses incurred in providing
the following services:
(
a) processing an application for an adoption placement
or processing a direct placement adoption;
(
b) preparation of a social history of
(
i) a child who is adopted or intended to
be adopted, and
(ii) the biological parents of the child;
(
c) preparation of a medical history of the biological
parents of a child who is adopted or intended to be adopted;
(
d) preparation by a physician of a medical report in
respect of a child who is intended to be adopted;
(
e) preparation of a home assessment report in respect
of an applicant or a person who has applied under
section 16.1(1) to have a
direct placement adoption processed by the agency;
(
f) preparation of an update of a home assessment
report;
(
g) pre-placement counselling services for an
applicant;
(
h) transportation relating to the placement of a child
for adoption;
(
i) preparation of a post-placement assessment;
(
j) preparation, filing and service of documents and
notices relating to an adoption and a petition for an adoption order;
(
k) post-placement counselling services provided under
section 17(1);
(
l) transfer between agencies of an application for an
adoption placement;
(
m) legal services provided in connection with an
adoption;
(
n) any other services relating to an adoption that, in
the opinion of a director, are necessary.
(2) An agency may charge to each approved applicant a flat rate fee
to cover
(
a) counselling services concerning a proposed adoption
placement that are requested by a guardian who wishes to place a child for
adoption through the agency, and
(
b) post-placement counselling services requested by a
guardian who has placed a child for adoption through the agency.
(3) An agency may charge a person who applies under
section 16.1(1)
to have a direct placement adoption processed a flat rate fee to cover
post-placement counselling services that may be requested by a parent who
placed a child for adoption through a direct placement, where the agency is
processing or has processed the adoption.
(4) An agency may charge to a person whose child has been adopted
the fees and expenses incurred in providing that person with counselling
services relating to the adoption, where
(
a) the counselling services have been requested by
that person, and
(b) 6 months has passed since the granting of the
adoption order, if the adoption was processed through the agency.
(5) Not later than 30 days after the making of an adoption order, an
agency shall provide to a director an itemized statement showing the fees
charged in respect of the adoption.
Section 24(2)(
d) is amended by adding the following after subclause
(i):
(i.1) a person who has applied under
section 16.1(1) to have a direct
placement adoption processed,
Section 25 is repealed and the following is substituted:
PART 2
AUTHORIZATION FOR ADOPTION PLACEMENT
BY INTERMEDIARY
Application for authorization
25 Any adult who maintains his usual residence in Alberta may apply
to a director on Form 8 for authorization to place or facilitate the
placement of a child for the purpose of an adoption.
Decision of director
26 On receiving an application under
section 25, a director may
interview the applicant to determine if the applicant is a suitable person
to place or facilitate the placement of a child for the purpose of an
adoption, and may
(
a) provide an authorization to the applicant on Form
9, or
(
b) refuse to provide an authorization to the
applicant.
Relevant considerations
27 In making a decision to provide or refuse to provide an
authorization under
section 26, a director shall consider the following, as
well as any other relevant matter:
(
a) the exceptional nature of the applicant's proposed
involvement in placing or facilitating the placement of a child for the
purpose of an adoption;
(
b) the applicant's proposed involvement during and
after finalization of the adoption;
(
c) the applicant's relationship to the child's
biological parents and the prospective adoptive parents;
(
d) the wishes of the biological parents with respect
to the applicant's involvement in the adoption;
(
e) the applicant's knowledge of adoption and the
adoption process;
(
f) how the proposed adoption placement will meet the
child's cultural needs;
(
g) whether the applicant will receive any form of
benefit from the proposed placement;
(
h) whether the applicant is affiliated with, or acting
as an agent for, any person who purports to carry on the business of
placing or facilitating the placement of children for adoption.
Notice of decision
28 A director shall, within 14 days after receiving an application,
advise the applicant in writing of a decision made under
section 26.
PART 3
LICENSED SEARCH AGENCIES
Definitions
29 In this Part,
(a) "adoption search" means a search conducted by an
agency for the location of a family member;
(b) "agency" means a licensed search agency;
(c) "applicant", except in sections 30 and 32, means a
person who applies to an agency pursuant to
section 66.2 of the Act;
(d) "family member" means
(
i) a biological parent of the applicant;
(ii) a biological adult sibling of the
applicant, unless that sibling was adopted;
(iii) if a biological parent of the applicant
is deceased, any adult related by blood to the deceased parent, unless that
person was adopted;
(e) "post-adoption registry" means the service provided
by the Minister under
section 66.1 of the Act.
Application for search agency licence
30(1) In this
section and
section 32, "applicant" means a person who
applies to a director for a licence to operate a search agency.
(2) An application for a licence to operate an agency shall be on
Form 1 and shall be accompanied by the following documentation:
(
a) evidence that the applicant is a corporate body
described in
section 69.1(1) of the Act;
(
b) evidence that the applicant has obtained general
liability insurance, satisfactory to the director, covering the proposed
agency and its employees;
(
c) a list of staff and contract positions, including a
job description for each position and the qualifications and experience
required for each position;
(
d) a written description of the applicant's proposed
program and procedures, including an explanation of the applicant's policy
regarding
(
i) provision of counselling services for
applicants and family members,
(ii) investigative procedures and practices
used in an adoption search,
(iii) contact with located family members,
and
(iv) advertising of agency services;
(
e) a fee
schedule for the services to be provided by
the agency;
(
f) any other information that the director considers
necessary to enable the director to determine the capacity of the applicant
to provide the services and carry out the responsibilities of an agency.
(3) An application for the renewal of a licence to operate an agency
shall be on Form 1 and shall be accompanied by
(
a) a statement of any changes in any of the
information referred to in subsection (2)(b), (c), (
d) or (
e) since that
information was last provided by the applicant, and
(
b) any other information that the director considers
necessary to enable the director to determine the capacity of the applicant
to continue to provide the services and carry out the responsibilities of
an agency.
Fee
31(1) The fee payable with an application under
section 30 is
(a) $100 for an initial licence, or
(b) $50 for the renewal of a licence.
(2) A fee referred to in subsection (1) is non-refundable.
Inspection
32 On receiving an application for a licence to operate an agency,
a director may inspect or cause to be inspected the premises from which the
applicant proposes to operate the agency for the purpose of determining
whether the applicant will be in compliance with the Act and this
Regulation.
Licence to be available for inspection
33 A licence or conditional licence to operate an agency shall be
kept on the premises of the agency and shall be available for inspection by
any person.
Application for an adoption search
34(1) Any person who is 18 years of age or over and who was adopted
in Alberta may apply to an agency on Form 10 for an adoption search.
(2) On receiving an application under subsection (1), an agency
shall
(
a) provide the applicant with a written description of
the services provided by the agency and the fee
schedule for those
services,
(
b) advise the applicant of the services available
through the post-adoption registry, and
(
c) provide a director with a copy of the application
within 14 days after receipt of the application.
Release of identifying adoption information
35(1) On receiving a copy of an application under
section 34, a
director may provide the agency with any identifying adoption information
that may assist the agency in carrying out an adoption search with respect
to that application.
(2) If the director advises the agency that a family member has
registered a veto under
section 66.2 of the Act, the agency
(
a) shall advise the applicant that the veto has been
registered,
(
b) shall not commence an adoption search for that
family member, and
(
c) shall not release personal information about that
family member to the applicant, other than information specified on the
veto, the release of which has been consented to by the family member.
(3) If the director advises the agency that a family member has
applied to the post-adoption registry, the agency shall advise the
applicant of that application.
Duty of agency to ensure confidentiality
36 Where an agency uses the services of a person who is not an
employee of the agency to conduct an adoption search, the agency shall
(
a) ensure that no identifying information about the
applicant, other than the applicant's birth name, is provided to that
person, and
(
b) take all reasonable steps to ensure that the person
maintains confidentiality with respect to any identifying adoption
information provided to that person by the agency and any other information
concerning the applicant or a family member that comes to the attention of
that person while conducting the adoption search.
Location of a family member by an agency
37(1) When an agency locates a family member through an adoption
search, the agency shall ensure that any contact between the agency and the
family member is made by a qualified person.
(2) When a family member is first contacted by a qualified person,
the qualified person shall advise the family member
(
a) that an application for an adoption search has been
made, without providing identifying information about the applicant,
(
b) that the family member has a right to
(
i) consent to a reunion with the applicant
on Form 11, or
(ii) register a veto on Form 12 declining a
reunion with the applicant and
(
A) prohibiting the release of
identifying information to the applicant, or
(
B) consenting to the release
of specified information to the applicant through the agency,
(
c) that counselling services are available through the
agency,
(
d) of any veto registered by another family member
with respect to the applicant, and
(
e) of the applicant's right to commence an adoption
search for other family members.
(3) If the family member consents to a reunion with the applicant
and the applicant chooses to use the services of the agency to facilitate
the reunion, the agency shall ensure that the reunion is facilitated by a
qualified person.
(4) If the family member chooses to register a veto declining a
reunion with the applicant, the agency shall send the veto to a director
within 10 days after receiving it, and shall, through a qualified person,
(
a) advise the family member of the right to revoke the
veto,
(
b) notify the applicant of the veto,
(
c) if the family member has consented on the veto to
the release of specified information to the applicant, provide the
applicant with that information, and
(
d) explain to the family member the importance of
providing medical information to the applicant.
(5) If the family member has not, within 90 days after being
contacted by the qualified person under subsection (2), either consented to
a reunion with the applicant or registered a veto, the agency shall handle
the matter as if the family member had registered a veto, and shall
(
a) notify a director within 10 days after the
expiration of the 90-day period that the matter is being handled as if a
veto had been registered,
(
b) notify the applicant that the matter is being
handled as if a veto had been registered, and
(
c) notify the family member that the matter is being
handled as if a veto had been registered.
Transfer of information to a director
38 On concluding an adoption search, an agency shall close its file
and transfer to a director all information relating to the search in the
possession of the agency or any person who conducted a search on behalf of
the agency, including
(
a) any information about the applicant or the family
member, whether obtained from a director or through the adoption search,
(
b) a confirmation of the outcome of the adoption
search,
(
c) an itemized statement showing the fees and
disbursements charged to the applicant and, if applicable, the family
member, and
(
d) in cases where the agency used the services of
investigators or other professionals who were not employees of the agency,
the names of those professionals and the services they provided.
Duty to provide statements and reports
39(1) An agency shall, on or before the last day of the 3rd month
immediately following the end of the agency's fiscal year, submit to a
director
(
a) an annual financial statement prepared by
(
i) a certified general accountant or a
professional corporation as those terms are defined in the Certified
General Accountants Act,
(ii) a certified management accountant or a
professional corporation as those terms are defined in the Certified
Management Accountants Act, or
(iii) a chartered accountant or a
professional corporation as those terms are defined in the Chartered
Accountants Act,
and
(
b) an annual report on the operation of the agency
during the year to which the annual report relates, including the number of
(
i) applications for adoption searches
received,
(ii) reunions facilitated by the agency,
(iii) reunions where the applicant did not
request the services of the agency,
(iv) vetos actually registered,
(
v) vetos registered by default under
section 37(5),
(vi) cases where the family member was not
located, and
(vii) requests received for counselling from
applicants and family members.
(2) An agency shall submit to a director any statistical information
and reports relating to the operation of the agency that the director may
require.
Designation of program director
40(1) An agency shall designate a qualified person as the program
director of the agency, who is responsible for the day to day operation of
the program of the agency, including the supervision of persons delivering
the services of the agency.
(2) An agency shall notify a director in writing not later than 10
days after
(
a) the designation of a program director, and
(
b) any change in the designation of a program
director.
Fees payable by applicants and family members
41(1) An agency may charge to an applicant the fees and expenses
incurred in providing the following services:
(
a) processing an application for an adoption search;
(
b) conducting an adoption search;
(
c) contacting a family member;
(
d) facilitating a reunion;
(
e) counselling services requested by an applicant;
(
f) any other services relating to adoption searches
that, in the opinion of a director, are necessary.
(2) An agency may charge to a family member the fees and expenses
incurred in providing counselling services requested by the family member.
Money to be held in a trust account
42(1) An agency that requires payment in advance for any of its
services shall establish and maintain a trust account in a bank, treasury
board or trust company, and any funds received from a person who will be
receiving services from the agency shall be deposited in the trust account.
(2) Money paid into a trust account under subsection (1) may be
withdrawn from the account only with the consent of the person for whom it
is held and only for fees and expenses specified in
section 41 incurred by
the agency for services provided to that person.
(3) Money remaining in a trust account after fees and expenses are
paid shall be returned to the person who paid the money to the agency.
(4) An agency shall keep a separate book of accounts showing the
deposits and withdrawals from the trust account, the name of the person for
whom each deposit or withdrawal is made and the date of each deposit or
withdrawal.
Advertising
43(1) An agency may advertise only in accordance with this section.
(2) Advertising by an agency
(
a) shall be in good taste,
(
b) shall be truthful, accurate and not misleading to
the public,
(
c) shall not claim or imply that the services of the
agency are superior to those of another agency,
(
d) shall not guarantee the location, or reunification
with, a family member, and
(
e) shall not publicize any service or activity that
could identify an applicant or a family member.
(3) A director who is of the opinion that advertising by an agency
contravenes subsection (2) may, in writing, order the agency to take the
measures specified in the order within the time limits specified in the
order.
Financial assistance
44(1) An agency may, on behalf of an applicant who is a resident of
Alberta, apply to the Minister for financial assistance with respect to an
adoption search.
(2) The Minister may provide financial assistance with respect to an
applicant who
(
a) receives a benefit under the Assured Income for the
Severely Handicapped Act, or
(
b) is 65 years of age or older and whose income for
calculating benefits, as defined in the Seniors Benefit Regulation (Alta.
Reg. 213/94), does not exceed the amount prescribed under that regulation.
(3) An applicant may receive financial assistance under
subsection (2) only once.
PART 4
POST-ADOPTION SUPPORT
Definitions
45 In this Part,
(a) "adopting parent" means
(
i) a person who has adopted a child, or
(ii) a person with whom a child has been
placed for the purpose of adoption;
(b) "special need" means a medical, physical, mental or
emotional condition or history that could significantly impede normal
development.
Post-adoption support agreement
46(1) Subject to this section, the Minister may enter into a
post-adoption support agreement in Form 13 with an adopting parent of a
child referred to in
section 67.1 of the Act respecting the provision of
financial support to the adopting parent to assist the adopting parent in
either or both of the following:
(
a) maintaining the child in the adoptive home;
(
b) providing the child and the family of the adopting
parent with any of the following services that may be required to meet the
special needs of the child:
(
i) medical services;
(ii) orthodontic and corrective dental
treatment;
(iii) home renovations or equipment required
to accommodate a disability;
(iv) occupational, speech, hearing or
psychological therapy;
(
v) day care for remedial purposes;
(vi) specialized educational support;
(vii) transportation and subsistence for
treatment purposes;
(viii) child care to provide parental
relief, to a maximum of 504 hours per year;
(ix) treatment in a residential facility in
Alberta.
(2) An agreement may be entered into under subsection (1)(
a) only if
an adoption order in respect of the child has not been made and
(
a) a director has, for a period of not less than 6
months, made reasonable efforts to find an adoptive home for the child
without the provision of financial support and the child
(
i) is one of 2 or more siblings who have
been placed with the adopting parent for the purpose of adoption,
(ii) is difficult to place for adoption due
to the age or special needs of the child, or
(iii) has a special cultural need that can be
met through the adoption of the child by the adopting parent.
(
b) the child has a special familial need that can be
met through the adoption of the child by the adopting parent, or
(
c) the child has developed a significant relationship
with the adopting parent as a result of the adopting parent providing care
as a foster parent to the child for an extended period of time and the
child
(
i) is one of 2 or more siblings who have
been placed with the adopting parent for the purpose of adoption,
(ii) is difficult to place for adoption due
to the age or special needs of the child, or
(iii) has a special cultural need that can be
met through the adoption of the child by the adopting parent,
(3) An agreement may be entered into under subsection (1)(
b) only
if, before the adoption order relating to the child was made, the special
needs of the child were
(
a) identified or anticipated, and
(
b) documented on Form 14.
(4) No agreement shall be entered into under subsection (1)(
b) if
the adopting parent is reasonably able to obtain the services required to
meet the special needs of the child from other sources.
(5) No agreement under subsection (1)(
a) or (
b) remains in force
after the child reaches the age of 18 years.
Rate of support
47 The rate of financial support provided under an agreement under
section 46(1)(
a) shall not exceed 90% of the basic maintenance rate for
foster care as set by the Minister from time to time.
Review of a post-adoption support agreement
48(1) The Minister shall review a post-adoption support agreement
(
a) annually, and
(
b) within 30 days after receiving a written request
for a review from the adopting parent who is a party to the agreement.
(2) If, after a review under subsection (1), the Minister is of the
opinion that
(
a) the special needs of the child have changed, or
(
b) the financial ability of the adopting parent to
maintain the child or to provide the services required to meet the special
needs of the child, as the case may be, has changed,
the Minister may require that the agreement be varied or may
terminate the agreement on 30 days' written notice to the adopting parent.
Appeal
49 A person who is affected by a decision respecting the refusal or
failure to enter into an agreement under
section 46 or respecting the terms
or the termination of that agreement may appeal the decision to an Appeal
Panel in accordance with
section 86(3) of the Act.
24 Forms 1 to 9 are repealed and the attached Forms 1 to 16 are
substituted.
25 The Post-adoption Support Regulation (Alta. Reg. 92/90) is repealed.
26 This Regulation comes into force on March 31, 1995.
FORM 1
APPLICATION FOR A LICENCE OR TO RENEW
A LICENCE TO OPERATE AN ADOPTION AGENCY
OR A SEARCH AGENCY
Regarding the application of (corporate name of applicant) I am
(name) . I am authorized to represent the applicant.
Application
I am applying:
for a licence to operate a licensed adoption agency
for a licence to operate a licensed search agency
to renew a licence to operate a licensed adoption agency
to renew a licence to operate a licensed search agency
I have attached all the supporting documents required by
section 2 or
section 30 of the Adoption Regulation.
I have enclosed the non-refundable application fee of:
$100 for an initial licence
$50 to renew a licence
Information about Applicant
1. Information about the applying corporate body:
Registered office address:
(telephone number)
Board of Directors:
(name) (title) (address)
(name) (title) (address)
(name) (title) (address)
2. Information about the agency, if different from the corporate
body:
(name)
(address) (telephone number)
3. (Program Director)
Signatures
(authorized
officer's signature) Corporate Seal:
(authorized
officer's signature)
FORM 2
NOTICE OF DECISION: LICENSING OF
ADOPTION AGENCY OR SEARCH AGENCY
To: (name of applicant or licensee)
Address: (street, apt #. P.O. Box #)
(city,town,county) (province) (postal code) (phone number)
Licensing
With respect to the licensing of:
an adoption agency
a search agency
Pursuant to
section 70.1 of the Child Welfare Act, I give notice of
my decision to:
(Place an "X" in the appropriate box.)
refuse to issue a licence to operate an agency
refuse to renew your licence to operate an agency
issue a conditional licence to operate an agency
suspend your licence to operate an agency until
cancel your licence to operate an agency.
The reasons for my decision are as follows:
You may appeal any decision noted on this form in accordance
with
section 86 of the Child Welfare Act.
This decision takes effect 30 days after the date of service of
this notice.
Signature of Director
(director's signature)
FORM 3
REQUEST FOR CHILD WELFARE RECORD CHECK
To: A director
Alberta Family and Social Services
Name of applicant:
(full name and all previous names)
(full name and all previous names)
Regarding each applicant:
I have applied to (name of licensed adoption agency)
(check one of the following)
to:
place a child in my home for adoption
process my adoption of a child placed in my home by the parent.
Please check for any child welfare records about me. Please send the
results of your check to me at: (address)
(check one of the following)
I have no other child.
My other children are: (name)
(name)
Signatures
(applicant's
(witness's signature) signature )
(applicant's
(witness's signature) signature )
Results of Child Welfare Record Check
I, (name) , (position) have conducted a child
welfare record check on (applicant) and report as follows:
I have no concern regarding the suitability of the applicants
to have the care and custody of a child.
I have the following concern regarding the suitability of the
applicants to have the care and custody of a child:
(Signature)
FORM 4
UPDATE REPORT
Name of applicant(s):
Address:
Telephone: Business (male applicant)
Business (female applicant)
Assessment
Describe under the following headings the circumstances of any
changes that have occurred since the completion of the home assessment
report:
Part A Yes No Changes
Health
Education
Sources of income
Employment
Residence
Religion
Part B Yes No Changes
Marital relationships
Family composition
Understanding of adoption issues
Child desired
Any other significant changes
Part C Yes No Changes
References
Signatures
(Signature of applicant)
(Signature of applicant)
FORM 5
CHILD'S SOCIAL AND FAMILY HISTORY
Section 1: Child's Information
Name of child:
Birthplace: Religion:
Has child been baptized: yes no
If yes, give details:
Racial Origin: Ethnic Origin:
If registered Indian, (registration number) Band: (name)
(number)
If Metis: (metis settlement name or community)
Physical description of child:
Diagnosed birth or congenital health problems of child:
Background (if newborn do not complete)
Provide any information regarding where the child has lived,
who parented the child, etc.
Describe relationship with family or other significant persons:
Development (if newborn do not complete)
Discuss academic achievement and social adjustment to school:
Describe any interests, hobbies or participation in sports:
Provide copies of any psychological or psychiatric assessments
which have been completed:
Provide any known information regarding the child's emotional,
social or cognitive functioning.
Personality (if newborn do not complete)
Discuss child's personality and behaviour.
Section 2: Birth Mother's Information
Name of mother:
Birthplace: Religion:
Racial Origin: Ethnic Origin:
If registered Indian, (registration number) Band: (name) Band:
(number) If Metis: (metis settlement name or community)
Marital status:
Physical description: (height) (weight) (colour of eyes)
(colour of hair)
Any unique features:
Education: Employment:
Interests:
Personality:
Relationship with family:
Other children born to birth mother:
(name)
(name)
Who is caring for these children:
Birth mother's parents, brothers and sisters
(name) (address)
(name) (address)
Describe any special talents, skills, traits within the family:
Additional comments of birth mother:
(signature of birth mother)
Section 3: Birth Mother's Medical Information
Describe the mother's general state of health:
Describe physical, mental, emotional or medical conditions and
treatment obtained for those conditions:
Describe extent of use of any drugs, alcohol or tobacco
(including prenatal use):
Describe prenatal care received by mother:
Describe any significant physical, mental, emotional or medical
conditions within the extended family:
Section 4: Birth Father's Information
Name of father:
Birthplace: Religion:
Racial Origin: Ethnic Origin:
If registered Indian, (registration number) Band: (name) Band:
(number) If Metis: (metis settlement name or community)
Marital status:
Physical description: (height) (weight) (colour of eyes)
(colour of hair)
Any unique features:
Education: Employment:
Interests:
Relationship with family:
Personality:
Other children born to birth father:
(name)
(name)
Who is caring for these children:
Birth father's parents, brothers and sisters
(name) (address)
(name) (address)
Describe any special talents, skills, traits within the family:
Additional comments of birth father:
(signature of birth father)
Section 5: Birth Father's Medical Information
Describe the father's general state of health:
Describe physical, mental, emotional or medical conditions and
treatment obtained for those conditions:
Describe extent of use of any drugs, alcohol or tobacco:
Describe any significant physical, mental, emotional or medical
conditions within the extended family:
Section 6: Adoption Information
Describe the relationship between the birth parents:
Describe the circumstances surrounding the decision to choose
adoption:
Is a letter or gift being left for the child?
Have the mother and father been given background information
about the adoptive family?
Is the birth father aware that the child has been placed for
adoption? yes no
Additional comments of person preparing history:
(prepared by) (date) (reviewed by) (date)
FORM 6
MEDICAL REPORT
Regarding the child (name) , born
Personal Health Number .
Referral
To: (physician's name) From: (child welfare worker)
(district office)
(address)
(phone)
Information from most recent care giver
I also have concerns about:
Feeding seems normal for age (e.g. development delays,
I am concerned about abuse, behaviour)
Sleeping seems normal for age
I am concerned about
Elimination seems normal for age
I am concerned about
Development seems normal for age
I am concerned about
Temperament seems normal for age
I am concerned about
Information from child welfare worker
Child's medical history: (PRENATAL: mother's health, nutrition, use of
alcohol, tobacco, other substances;
BIRTH: apgars; CHRONIC ILLNESS, HOSPITALIZATION, ABUSE)
Immunizations up to date
not up to date
Name of health unit
Allergies
I also have concerns about
To be completed by a registered physician
Laboratory findings (complete as necessary)
Test
Results
Blood Type
Urinalysis
Urine C/S
TB test
Other
Physical examination (complete as applicable)
Head circumference ' % tile
Height ' % tile
Weight ' % tile
Blood pressure ' % tile
Normal Abnormal N/A
Ant Fontanel
Head (shape/size)
Ears
Eyes
Oropharynx
Teeth
Lymph nodes
Skin
Nutrition/Iron
Endocrine
Respiratory
Heart
Abdomen
Umbilicus
Femoral pulses
Hernias
Genitalia
Nervous system
Upper limbs
Lower limbs
Hips
Vision
Hearing
Concerns
Summary
Assessment
Summary
Healthy child; no concerns
Diagnosis
Prognosis
Care plan and/or recommendations (describe follow-up plan)
Examining Physician
(name) (area of
practice)
(address)
(phone)
(physician signature)
FORM 7
POST-PLACEMENT ASSESSMENT
Name of applicant:
Name of child:
Assessment Information
I, (name) , (position) a qualified
person under the Child Welfare Act, have assessed the adjustment of the
applicant(
s) and the child to the placement of the child in the home of the
applicant(
s) and report as follows:
1. Describe the child's physical, mental and emotional level of
development.
2. Describe the child's contact with any health professionals and
the child's immunization program.
3. Describe the adjustment and bonding between the child, the
applicant(
s) and other family members.
4. Describe the home environment (including other people in the
home, parenting abilities, quality of spousal relationship).
5. Describe any efforts that have been made to retain the child's
cultural identity.
6. Describe the applicants understanding of being an adoptive
parent.
7. Provide comments by references regarding the adjustment of the
child and the family to the adoption.
8. Do you believe the completion of this adoption is in the
child's best interests?
(completed by) (position)
(reviewed by) (position)
FORM 8
APPLICATION FOR AUTHORIZATION
Information about applicant
Name of applicant: (name of applicant)
Address: (street, apt #, P.O. Box #)
(city,town,county) (province)
(postal code) (phone number)
Occupation:
Information about birth parents
Name of mother: (name of mother)
Address: (street, apt #, P.O. Box #)
(city,town,county) (province)
(postal code) (phone number)
Name of father: (name of father)
Address: (street, apt #, P.O. Box #)
(city,town,county) (province)
(postal code) (phone number)
Information about proposed adoptive parents
Names of proposed adoptive parents: (name of proposed adoptive
mother) (name of proposed adoptive father)
Address: (street, apt #, P.O. Box #)
(city,town,county) (province)
(postal code) (phone number)
Information about child
Name of child (if born): (name)
Date of birth or expected date of birth:
To be completed by applicant
I am applying for authorization to place or help place this child for
the purpose of adoption.
I want to be involved in placing this child because:
My involvement in placing this child is exceptional because:
My role in assisting with this adoption following placement of the
child and following the granting of the adoption order will be:
My relationship to the birth parents of this child is:
My relationship to the proposed adoptive parents is:
My knowledge of adoption and the adoption process is based on:
The proposed adoption placement will meet the child's cultural needs
because:
(check one of the following:)
I will receive the following benefit for being
involved in this adoption:
I will not receive a benefit of any kind for being
involved in this adoption.
(check one of the following:)
I am affiliated with a person or organization that
carries on an adoption business. The name of the person or organization is
I am not affiliated with any person or organization
that carries on an adoption business.
To be completed by birth parents
I/We want the applicant to be involved in my/our child's adoption
because:
Notice to birth parents and proposed adoptive parents:
Adoption services are available to birth parents and adoptive parents
from Alberta Family and Social Services and from licensed adoption
agencies. Contact your nearest district office of Family and Social
Services for further information.
Signatures
(witness's
signature) (applicant's signature)
(witness's
signature) (birth parent's signature)
(witness's
signature) (birth parent's signature)
(witness's (proposed adoptive
signature) parent's signature)
(witness's (proposed adoptive
signature) parent's signature)
THIS IS NOT A CONSENT TO ADOPTION
FORM 9
AUTHORIZATION
To: (name of applicant)
Address: (street, apt #, P.O. Box #)
(city,town,county) (province) (postal code)
Information about Child
Name of child (if born): (name)
Date of birth or expected date of birth:
Information about Birth Parents
Names of birth parents: (name of birth mother)
(name of birth father)
Information about Proposed Adoptive Parents
Names of proposed adoptive parents: (name of proposed
adoptive mother) (name of proposed adoptive father)
Authorization
You are authorized by a director to place or help place this child
with the proposed adoptive parents for the purpose of adoption.
This authorization allows you to place the child only if the birth
parent wants you to.
The provisions of the Child Welfare Act apply at all times. The Act
requires the birth parent's consent to the child's adoption.
Signature
(signature of director)
FORM 10
APPLICATION FOR AN ADOPTION SEARCH
Name: (first name) (middle name) (last name)
Address: (street, apt #, P.O. Box #)
(city,town,county) (province) (postal code)
Telephone No. (residence) (business)
Previous names
To: (name of licensed search agency)
Address:
Search Information
I would like you to search for: my birth mother,
my birth father, my birth sisters and brothers.
If my birth parent is dead, I would like you to search for any adult
related by blood to that birth parent Yes No
Date of adoption
Place of birth
My adoptive mother is (last name) (first name)
My adoptive father is (last name) (first name)
I believe I have the following birth brothers and sisters.
(Please give names and any details you know about sisters and brothers. If
you need more space, attach a separate sheet):
I understand that a director will give you identifying information
about me and my birth family to help you with the search.
Signatures
(witness) (signature of applicant)
FORM 11
CONSENT BY FAMILY MEMBER
To: (name of licensed search agency)
(address)
Consent
I am (name of family member) . I understand that my birth
(relationship at birth) , who was adopted, has asked you to find me.
I give you my consent to reunite him or her with me.
I give you my consent to give him or her any information
you have that identifies who I am.
Signatures
(witness) (signature of family
member)
FORM 12
VETO
To: A director
Alberta Family and Social Services
c/o (name of licensed search agency)
(address)
Veto
I am (name of family member) . I understand that my birth
(relationship at birth) , an adult adoptee, has asked a licensed search
agency to find me. I do not want to be reunited with him or her.
1. I forbid the release of any information that identifies
who I am to the adult adoptee, except for the information I have provided
below.
2. I give my consent to give the adult adoptee the following
medical and/or other information about me:
I understand that even if I register this veto form, the adult
adoptee still might find another birth family member. That member might
give out information about me. I understand that even if I register this
veto form, the adult adoptee still might find me or get information about
me some other way.
I understand that I may cancel this veto any time by writing to the
Post Adoption Registry.
Signatures
(witness) (signature of family
member)
FORM 13
POST-ADOPTION SUPPORT AGREEMENT
Regarding the child (name) , born
Agreement
This agreement is made according to
section 67.1 of the Child Welfare
Act.
This agreement is between the Minister and (name of adoptive parents)
of (address) .
This agreement replaces the agreement we entered
The Minister agrees to review this agreement within 30 days of
receiving a written request from the parents.
We agree that this agreement may be changed only if both of us agree.
To change this agreement, we will sign a new agreement.
We agree that if one of us wants to cancel this agreement, we will
provide a letter to the other person 30 days before the date we want the
agreement to end.
We agree to the terms set out below this agreement. The total cost
of this agreement will not exceed .
Terms
Maintenance Terms
This child has been placed with the parents for the purpose of
adoption. The parents require financial support to assist them to maintain
the child in their home.
The Minister agrees to provide the parents with financial support to
maintain the child. The rate of support will be: .
The parents agree to inform the Minister about any change in their
ability to maintain the child.
We agree that these terms will be effective from
to unless cancelled earlier.
(NOTE: The agreement may not exceed one year or continue after the
child's 18th birthday.)
Special Service Terms
This child was adopted by the parents on
Before the adoption, a director acknowledged that the child had
special needs.
The Minister agrees to provide the parents with financial support for
services to meet the child's special needs.
The level of support and the type of services will be:
The parents agree to make sure the child receives the services
described above.
The parents agree to inform the Minister about any change in the
child's special needs.
We agree that these terms will be effective from:
the date the adoption order is granted.
We agree that these terms end
unless cancelled earlier.
(NOTE: The agreement may not exceed one year or continue after the
child's 18th birthday.)
Signatures
(parent's (parent's
signature) signature)
(Minister's
(child welfare delegate's
worker's signature) signature)
FORM 14
ACKNOWLEDGMENT OF SPECIAL NEED
Regarding the child (name) , born
My name is (name of child welfare worker) . I am referring
this child for adoption.
Current Condition
This child has the following medical, physical, mental or emotional
condition:
Because of this condition, the child needs the following treatment or
services:
History
This child has the following medical, physical, mental or emotional
history:
Because of this history, the child might need the following treatment
or services:
The attached document confirms the child's condition or history.
The document was completed by:
a physician or dentist
a qualified person as defined in the Qualification Regulation
(Alberta Regulation 185/85):
(
a) a social worker registered under the Social Workers Act,
(
b) a psychologist registered under the Psychologists Act,
(
c) a person who holds at least a Bachelor's degree in Social Work
from a university or school accredited by the Canadian Association of
Schools of Social Work, or
(
d) a person who in the opinion of the Minister is qualified
because of his academic qualifications or his experience or a combination
of his qualifications and experience.
(child welfare worker's signature),
(casework supervisor's signature) ,
(director's designate's signature) ,
FORM 15
NOTICE BY AN ADOPTION APPLICANT
ABOUT A DIRECT ADOPTION PLACEMENT
Regarding the child (name as on birth document) ,
born at (place of birth) .
Applicants
We are the applicants who will be applying to adopt this child:
(applicant) (applicant)
(address) (phone)
Parents
This child's parents are:
Mother: (name) , born
(address) (phone)
Father: (name) , born
(address) (phone)
Notice
This is your notice that we received custody of this child from
the parent on for the purpose of adoption. We
intend to apply for an adoption order regarding the child.
(applicant's signature) ,
(applicant's signature) ,
FORM 16
NOTICE BY A PARENT ABOUT A
DIRECT ADOPTION PLACEMENT
Regarding the child (name as on birth document) ,
born at (place of birth) .
Parents
I am this child's parent. I am:
(name) , born
(address) (phone)
The child's other parent is:
(name) , born
(address) (phone)
Applicants
The people who will be applying to adopt my child are:
(applicant's legal name) (applicant's legal name)
(address) (phone)
Notice
This is your notice that I placed this child with the applicants
on for the purpose of adoption.
I understand that you will need me to sign a consent form for the
adoption. This is how you can contact me:
(parent's signature) ,
------------------------------
Alberta Regulation 42/95
Child Welfare Act
GENERAL AMENDMENT REGULATION
Filed: March 8, 1995
Made by the Minister of Family and Social Services (M.O. 16/95) pursuant to
section 96(2) of the Child Welfare Act.
1 The General Regulation (Alta. Reg. 192/85) is amended by this
Regulation.
Schedule 1 is repealed and the attached
Schedule 1 is substituted.
3 This Regulation comes into force on March 31, 1995.
SCHEDULE 1
FORM 1
SUPPORT AGREEMENT WITH
A GUARDIAN OR CUSTODIAN
Regarding the child(ren):
(name) , born date (year/month/day) , ID#
(name) , born date (year/month/day) , ID#
Agreement
This agreement is made according to
section 7(1) of the Child Welfare
Act.
This agreement is between a director and (name) of
(address) who is the child's guardian custodian
We agree that this agreement will be effective from
to unless cancelled earlier.
We agree that if one of us wants to cancel the agreement, we will
provide a letter to the other person that sets a date for the agreement to
end.
We have seen and agree to the service plan of
that is attached to this agreement. We also agree that we can make
changes to the service plan if both of us agree to them.
Signatures
(guardian's/ (witness's
custodian's signature) signature )
(guardian's/ (witness's
custodian's signature) signature )
(director's (witness's
delegate's signature ) signature )
FORM 2
SUPPORT AGREEMENT WITH A CHILD
Regarding the child (name) , born
Agreement
This agreement is made according to
section 7(2) of the Child Welfare
Act.
This agreement is between a director and (name) of
(address) who is the child.
We agree that this agreement will be effective from
to unless cancelled earlier.
We agree that if one of us wants to cancel the agreement, we will
provide a letter to the other person that sets a date for the agreement to
end.
We have seen and agree to the service plan of
that is attached to this agreement. We also agree that we can make
changes to the service plan if both of us agree to them.
Signatures
(child's signature) ,
(witness's signature) ,
(director's delegate's signature) ,
(witness's signature) ,
FORM 3
CUSTODY AGREEMENT WITH A GUARDIAN
Regarding the child (name) , born
Personal Health Number
Agreement
This agreement is made according to
section 8(1) of the Child Welfare
Act.
This agreement is between a director and (name) of
(address) who is the child's guardian.
We agree that this agreement will be effective from
to unless cancelled earlier.
We agree that if one of us wants to cancel this agreement, we will
provide a letter to the other person that sets a date for the agreement to
end.
We agree to the terms set out below.
Terms
The guardian agrees that We agree that the
the director may: guardian will have the following contact with
the child:
decide about daily routines
decide about recreational activities
enroll the child in school or vocational activities
decide about religious or cultural activities
consent to ordinary medical or dental care
consent to emergency treatment or surgical procedures
consent to employment
consent to obtaining recreational licences and permits
(except a firearms permit or driver's licence)
other
The guardian agrees to contribute the The guardian will
make all
following toward maintaining the child: cash payments to:
dental costs cash payments of the
Provincial Treasurer by
optical costs $ per month. supplying them to the district
prescription drugs office at
school fees These payments will
clothing be made on the
recreation costs (day) of every
counselling fees month, starting
date (y/m/d)
other a one time cash the Director of
Maintenance
Enforcement at:
payment of $ (address)
paid by (date (y/m/d)
We have seen and agree to the service plan of date (y/m/d)
that is attached to this agreement. We also agree that we can make changes
to the service plan if both of us agree to them.
Signatures
(guardian's signature) (witness's signature)
(director's
delegate's signature) (witness's signature)
FORM 4
CUSTODY AGREEMENT WITH A CHILD
Regarding the child (name) , born
Personal Health Number .
Agreement
This agreement is made according to
section 8(2) of the Child Welfare
Act.
This agreement is between a director and (name) of
(address) who is the child.
We agree that this agreement will be effective from
to unless cancelled earlier.
We agree that if one of us wants to cancel the agreement, we will
provide a letter to the other person that sets a date for the agreement to
end.
We have seen and agree to the service plan of
that is attached to this agreement. We also
agree that we can make changes to the service plan if both of us
agree to them.
Signatures
(child's signature) (witness's signature)
(director's
delegate's signature) (witness's signature)
FORM 5
PERMANENT GUARDIANSHIP AGREEMENT
Regarding the child (name) , born
Introduction
The guardians of this child have asked the director to take over
guardianship of the child.
We understand that once we enter this agreement:
anyone who is now a guardian of the child will no longer be a
guardian
the director will become the child's only guardian
a guardian may end this agreement within 10 days after signing
it. To end the agreement, the guardian must give the director a written
request.
Agreement
This agreement is made according to
section 10 of the Child Welfare
Act.
This agreement is between a director and (names)
(names) who are all of the guardians of this child. We agree that
the director will assume guardianship of the child.
Signatures
(guardian) , (witness's
signature)
(guardian) , (witness's
signature)
(director's
delegate's signature), (witness's signature)
FORM 6
ACCESS, MAINTENANCE OR
CONSULTATION AGREEMENT
Regarding the child (name) , born
Agreement
This agreement is made according to:
section 9 of the
section 12 of the
section 32 of
the
Child Welfare Act Child Welfare Act Child Welfare
Act
(custody agreement (temporary (permanent
guardianship
with a child) guardianship order) order)
This agreement is between a director and (name) of (address) .
This agreement replaces the agreement we entered on
We agree that this agreement will be effective from
(NOTE: the expiry date may not be after the expiry date of the custody
agreement or guardianship order.)
This agreement may be replaced only if both of us agree. To replace this
agreement, we will enter a new agreement.
To cancel this agreement:
If there are no terms of maintenance, one of us will provide a
letter to the other person that sets a date for the agreement to end.
If there are terms of maintenance, only the director may cancel
the agreement.
We agree to the terms set out below.
Terms
Terms of Access (only if temporary or permanent guardianship)
We agree that (name) may have the following contact with the
child:
Terms of Maintenance (only if custody agreement or temporary guardianship)
The guardian agrees to contribute the following toward maintaining the
child:
dental costs clothing cash payments of $
optical costs recreation cost per month. These
payments
prescription drugs counselling fees will be made on
the (day)
school fees of every month starting
other date (year/month/day)
a one time cash payment of
$ dollars to be paid
by date (year/month/day) .
The guardian will make all cash payments to:
the Provincial Treasurer by supplying them to the district office at
(address).
the Director of Maintenance Enforcement at (address) .
Terms of Consultation (only if temporary guardianship)
The director agrees to discuss the following matters with the guardian:
Other Terms (only if temporary guardianship)
Consent to Access by a
Child 12 Years of Age or Over
(Complete if this agreement is with someone
who is not a guardian)
My name is (name) . I consent to the terms of access in
this agreement.
(child's signature) (witness's signature)
Signatures
(signature) (witness's signature)
(director's
delegate's signature) (witness's signature)
FORM 7
SECURE TREATMENT CERTIFICATE
Regarding the child (name) , born
My name is (name of director's delegate) . I have the
authority to act for a Child Welfare Director.
Certificate
This certificate is the authority for confining this child in a
secure treatment institution.
The certificate is issued by a director under
section 41 of the Child
Welfare Act.
The director has reasonable and probable grounds to believe that the
child is suffering from a mental or behavioral disorder, that the child is
in a condition presenting a danger to himself or others, and that it is
necessary to confine the child in order to remedy or alleviate the disorder
because: .
The director authorizes any person to confine the child in a
secure treatment institution from to
The secure treatment institution is (name) at (address).
(signature of director's delegate) ,
Notice
This is your notice that I will be appearing in Court to show cause
why this certificate was issued.
The court hearing will be at (address) on
A judge will hear my information as soon as possible after (time)
If you want to speak to the judge about my information, you must
attend the hearing.
The child may be represented by a lawyer at any appearance before the
Court. The nearest office of the Legal Aid Society is (address) ,
(phone) .
FORM 8
HANDICAPPED CHILD'S SERVICE AGREEMENT
Person ID
IN RESPECT of the child
Name of child Date of y m d
birth
AND IN ACCORDANCE WITH
section 72 of the Child Welfare Act
THIS AGREEMENT IS MADE BETWEEN
(hereinafter called the Guardian(s))
Address: (Apt. House Street No.) Phone No.
and a director or authorized designate (hereinafter called the DIRECTOR)
The guardian(
s) and the director agree that:
1. The director will provide the following:
2. The guardian(
s) will provide the following:
3. The guardian(
s) will provide medical insurance coverage under the
Alberta Hospitals and Medical Care Health Care Insurance Plan and, when
necessary, hospital or optional health services insurance coverage for the
child, the contract number(
s) being
Health Plan Name
Personal Health Number (eg. Blue Cross) No.
COMPLETE THE FOLLOWING only when the child is to be placed in the care or
custody or under the control or supervision of a director in order to
permit the provision of services or financial assistance to the family or
the child.
IF THIS
SECTION IS NOT APPLICABLE, DELETE AND INITIAL IN THE
APPROPRIATE MANNER.
4 (
a) In consideration of services provided to the child, the guardian
authorizes the director, and anyone acting on the director's behalf, to
make the following decisions:
Day to day care Consent to emergency
treatment or surgical procedures
Social activities Other
School enrolment,
vocational training
and employment
Acquisition of
recreational licences
and permits
(excluding firearms and
driver's licence)
Consent to ordinary
medical/dental care
(
b) The guardian understands that the Child Tax Benefit will not be paid
to the guardian during the time the child is placed in the care or custody
or under the control or supervision of a director.
5. This agreement is effective from y m d y m d
unless cancelled with notice in writing by the director or by the
guardian(s).
6. This agreement or any of its terms may be amended or
varied in writing with the consent of the guardian(
s) and the
director.
y m d
Dated Signed in the presence of:
Witness
Guardian
Witness
Guardian
Witness
Director or
Authorized Designate
District Office
Agreement No.
FORM 9
NOTICE OF APPEAL TO THE APPEAL PANEL
My name is (name) . My address is (address) My
telephone number is (telephone number) .
Right to Appea