Form 33D: Statement of Agreed Facts
(page 2)
Court file number
(Status Review)
1.
The information about the child(ren) in this case is as follows:
Full legal name of first child:
Date of birth
Age
Sex
Child’s religion
Child’s Indian or native status
Name of child’s band or native community
If child was apprehended, address and identity of place from which the child was removed
Full legal name of child’s mother by birth or by adoption
Full legal name of child’s father by birth or by adoption
Father’s status as “parent” under statute
Full legal name of second child:
Date of birth
Age
Sex
Child’s religion
Child’s Indian or native status
Name of child’s band or native community
If child was apprehended, address and identity of place from which the child was removed
Full legal name of child’s mother by birth or by adoption
Full legal name of child’s father by birth or by adoption
Father’s status as “parent” under statute
Full legal name of third child:
Date of birth
Age
Sex
Child’s religion
Child’s Indian or native status
Name of child’s band or native community
If child was apprehended, address and identity of place from which the child was removed
Full legal name of child’s mother by birth or by adoption
Full legal name of child’s father by birth or by adoption
Father’s status as “parent” under statute
If there are more children, attach a sheet and number it.
FLR-33D-E (2005/09)
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