Form No. 27

IN THE CHILDREN’S COURT

OF NEW SOUTH WALES

AT

CASE NO(S):

Application for Variation/Revocation Parent Capacity Order

Section 91H Children and Young Persons (Care and Protection) Act 1998
Date of Application:
Date filed:

Applicant: Secretary of the Department of Family and Community Services

Details of person filing application on behalf of the Secretary

Name of Delegate:
Address of CSC:
Position:

Respondent:

Name of respondent:
Address of respondent:
Relationship to child/young person:

Details of Parent Capacity Order:(Copy of order to be attached)

Date order made:
Place of order:

Child(ren)/Young person(s):

Child 1 / Child 2 / Child 3
Given name:
Family name:
Date of birth:
Age as at date of application:
Gender:
KiDS no.:
(Community Services identifier)
Child 4 / Child 5 / Child 6
Given name:
Family name:
Date of birth:
Age as at date of application:
Gender:
KiDS no.:
(Community Services identifier)

Parents/Carers:

Mother 1 / Father 1 / Carer 1[1]
Family name:
Given name:
Date of birth:
Address:
Mother 2 / Father 2 / Carer 2[1]
Family name:
Given name:
Date of birth:
Address:

NOTE: Include details of parents/carers whether or not a party to the Parent Capacity Order

Include carer details where the carer is a guardian or otherwise providing care for the child under an arrangement with the parents. Do not include where the carer is an authorised carer arranged by Community Services or an NGO unless the carer is a member of the extended family or kinship group and consents to disclosure of their details

APPLICATION DETAILS

Are you seeking tovary or revoke the Parent Capacity Order?

Variation

Revocation

GROUNDS OF APPLICATION

What are the grounds for making the application? Please include details of any significant change in relevant circumstances since the order was made or last varied.

TERMS OF ORDER SOUGHT

What change/s to the Parent Capacity Order are you requesting?

______

Signature of Applicant

Dated:

NOTICE OF LISTING

This Application has been listed before the

Children’s Court at: ………………………………………………

……..………………………………………..

on:

at: am/pm

______

Registrar

Children’s Court at

Dated:

1

[1]

[1]