Schedule 1

In force

Forms

FORM 1 — HEADINGS

[Rule 5(2)(c)]

Adoption Act 1994

In the Family Court of Western Australia

No. of .

IN THE MATTER OF............................................................................................

.................................................................................................................................

BETWEEN.............................................................................................................

.................................................................................................................................

[Applicant/s/Appellant/s]

AND........................................................................................................................

.................................................................................................................................

[Other parties to application/appeal]

_______________

FORM 2 — NOTICE OF ADDRESS (OR CHANGE IN ADDRESS) FOR SERVICE

[Rule 6]

Notice of Address (or Change in Address) for Service

Name.......................................................................................................................

.................................................................................................................................

Name of legal practitioner and legal practitioner’s firm (if applicable):.................................................

.................................................................................................................................

Address for Service:................................................................................................

.................................................................................................................................

[address must be within Western Australia]

Telephone no: ( )................................................................................................

Fax no: ( )...........................................................................................................

DX no:.....................................................................................................................

DATED this day of .

.................................................................

SIGNATURE of party or legal practitioner for party

_______________

[Form 2 amended: Gazette 29 Jan 2013 p. 335.]

FORM 3 — APPLICATION (GENERAL)

[Rule 9]

Application

(other than for an adoption order)

I/We.........................................................................................................................

of.............................................................................................................................

.................................................................................................................................

[State full name/s and address/es]

apply under section of the Adoption Act 1994 for the following order/s —

.................................................................................................................................

DATED this day of .

....................................................................................

SIGNATURE of applicant/s or legal practitioner for applicant/s

TAKE NOTICE that if you wish to oppose this application you must file a notice of address for service within 14 days of the day on which you received this copy of the application.

_______________

[Form 3 amended: Gazette 29 Jan 2013 p. 335.]

FORM 4 — APPLICATION FOR ADOPTION ORDER

[Rule 11]

Application for an adoption order

I/We ........................................................................................................................

.................................................................................................................................

[State full name, address and occupation of each prospective adoptive parent]

apply to adopt..........................................................................................................

.................................................................................................................................

[State full name by which prospective adoptee is known and the date and place of birth of the prospective adoptee]

a child from [insert the name of the Convention country], a Convention country, who is to live in Western Australia. [include if applicable]

In the event that an adoption order is made, I/we apply for the Court to declare that the adoptee be known by the name..................................................................

................................................................................................................................

DATED this day of .

...................................................

SIGNATURE/S of applicant/s

[*Note that if the application for the adoption order is in relation to a child, a written memorandum of the provisions of the adoption plan in relation to the child is to be filed with the application unless an application will be made for the Court to dispense with the requirement for the adoption plan: section 62 of the Act.]

[Form 4 inserted: Gazette 21 Mar 2000 p. 1498.]

_______________

FORM 4A — APPLICATION FOR ADOPTION ORDER UNDER SECTION 78A OF THE ADOPTION ACT 1994

[Rule 11A]

Application for an adoption order of child who is to live in a Convention country

I/We ........................................................................................................................

.................................................................................................................................

[State full name, address and occupation of each prospective adoptive parent]

apply to adopt..........................................................................................................

.................................................................................................................................

[State full name by which prospective adoptee is known and the sex and date and place of birth of the prospective adoptee]

an Australian child who is to live in [insert the name of the Convention country], a Convention country.

In the event that an adoption order is made, I/we apply for the Court to declare that the adoptee be known by the name..................................................................

................................................................................................................................

DATED this day of .

...................................................

SIGNATURE/S of applicant/s

[Note that a written memorandum of the provisions of the adoption plan in relation to the child is to be filed with the application unless an application will be made for the Court to dispense with the requirement for the adoption plan: section 62 of the Act.]

[Form 4A inserted: Gazette 21 Mar 2000 p. 1498‑9.]

_______________

FORM 4B — APPLICATION FOR ORDER UNDER SECTION 136B

[Rule 12A]

Application for an order terminating the legal relationship of child and parent in relation to a simple adoption

I/We ........................................................................................................................

.................................................................................................................................

[State full name, address and occupation of each applicant]

apply, under section 136B of the Adoption Act 1994, for an order terminating the relationship between ........................................................................................

.................................................................................................................................

[State the full names of the pre‑adoptive parents and any other names by which either parent is, or was previously, known]

and ..........................................................................................................................

.................................................................................................................................

[State the full name, sex, and date and place of birth of the child]

DATED this day of .

...................................................

SIGNATURE/S of applicant/s

[Form 4B inserted: Gazette 21 Mar 2000 p. 1499; amended: Gazette 17 Sep 2002 p. 4675; 29 Jan 2013 p. 335.]

_______________

FORM 4C — APPLICATION FOR A DECLARATION UNDER SECTION 136F

[Rule 12B]

Application for a declaration under section 136F of the Adoption Act 1994

I...............................................................................................................................

.................................................................................................................................

[State full name and address of the State Central Authority]

, the State Central Authority, apply, under section 136F of the Adoption Act 1994, for a declaration by the Court that the adoption of*/decision made in accordance with Article 27 of the Hague Convention in relation to*[whichever is applicable]...........................................................................................................

.................................................................................................................................

[State the full name, sex, date and place of birth of the child]

is not recognised.

DATED this day of .

...................................................

SIGNATURE/S of applicant/s

[Form 4C inserted: Gazette 21 Mar 2000 p. 1500; amended: Gazette 29 Jan 2013 p. 335.]

_______________

[Form 5 deleted: Gazette 29 Jan 2013 p. 335.]

FORM 6 — ACKNOWLEDGMENT OF SERVICE

[Rules 23(b)(ii) and 25(2)]

.................................................................................................................................

[State full name of person served with documents]

Date of service:.......................................................................................................

Document/s served:.................................................................................................

.................................................................................................................................

I acknowledge that the documents specified above were served on me on the date specified above.

........................................................................................

[Signature of person served]

.........................................................................................

[Date of signing]

I am the legal practitioner for the person served. On behalf of my client I acknowledge that the documents specified above were served on my client on the date of service specified above.

.........................................................................................

[Signature of legal practitioner]

.........................................................................................

[Date of signing]

.........................................................................................

[Name of legal practitioner and name of firm (print)]

.........................................................................................

[Address]

.........................................................................................

[Telephone no.]

.........................................................................................

[Fax no.]

.........................................................................................

[DX no.]

_______________

[Form 6 amended: Gazette 29 Jan 2013 p. 336.]

FORM 7 — WITNESS SUMMONS

[Rule 28(2)]

Summons to Witness

To:...........................................................................................................................

.................................................................................................................................

of.............................................................................................................................

.................................................................................................................................

You are hereby ordered to attend at this Court at....................................a.m./p.m.

on __________________ the __________________ day of ________________

at 150 Terrace Road, Perth in the State of Western Australia and to attend from day to day unless excused by the Court or a Registrar, until the hearing of the above‑mentioned matter is completed, to —

(a)

give evidence; or

(b)

give evidence and produce any books, documents or things in your possession or custody or under your control as are set out below; or

(c)

produce any books, documents or things in your possession or custody or under your control as are set out below.

[Delete the inapplicable paragraphs]

The books, documents or things to be produced are...............................................

.................................................................................................................................

If you fail or refuse to comply with this summons then —

(a)

a warrant may issue for your arrest; and

(b)

if you so fail without reasonable cause or excuse you commit an offence punishable by a fine not exceeding $1 000.

DATED this day of .

........................................................

REGISTRAR

[Form 8 deleted: Gazette 5 Dec 1995 p. 5587.]

[Schedule 1 amended: Gazette 5 Dec 1995 p. 5587; 21 Mar 2000 p. 1498‑1500; 17 Sep 2002 p. 4675; 20 Jun 2003 p. 2236.]

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