Family Justice Services – Request for Service The Request for Service Form: A Request for Service form allows families to work with a mediator to help find a solution to issues related to their children. It is not an application for a court hearing. All people involved must complete a Request for Service Form in full to receive service(s). It is important that you can communicate with all people involved. If you are unable to complete the form with the other people, a Request for Service may not be appropriate for you, and you may have to file a Court Application. Legal Advice: Family Justice Service does not provide legal advice. It is recommended that all people obtain legal advice before completing a Request for Service Form. This helps everyone understand their rights and what to expect. If you are not in a position to retain a private lawyer, you may qualify for Legal Aid. Contact information: Phone: 1-800-563-9911; Website: http://www.legalaid.nl.ca/index.html PLIAN may also be able to assist: The Public Legal Information Association of NL (“PLIAN”) is a community-based, non-profit organization. Like the Court, PLIAN staff cannot provide legal advice, but they can: Provide general legal information and legal navigation support. Assist you with finding a lawyer. PLIAN runs a Lawyer Referral Service and can refer you to a lawyer for a 30-minute consultation for $40 (tax included). For more information, contact PLIAN: Phone: 1-888-660-7788 or 709-722-2643; Email: info@publiclegalinfo.com; Website: https://publiclegalinfo.com The Request for Service process is Voluntary: All people must agree to be involved in the Request for Service process. No one is forced to participate. Instructions: Complete the Form and Attach Documents: Please fill out all parts of the form. Attach any important documents (e.g. financial documents) that support your request (30MB max. total) If information and/or documents are missing, this may delay your request or cause it to be declined. Time Limit: If FJS does not receive the completed electronic Request for Service Form from the other person(s) within 30 days of you submitting your Request for Service Form, your request will be closed. You can submit a new Request for Service Form later if circumstances change. Acceptance(Required) I have read and agree to the above and the Agreement to Participate.NOTE: The checking of the consent box below is recorded and will signify your reading, understanding and agreement to participate. To read this agreement click on the Agreement to Participate link.Request for Service FormPlease choose from the following. Additional entry fields will appear based on your selection(s).I am requesting services from Family Justice Services (FJS) in relation to the following:(Required) Custody / Decision-Making Access / Parenting Time Child Support Parent Information Services Decision-making responsibility means the responsibility for making important decisions about the child(ren)’s well-being. This includes decisions about the child(ren)'s: · health care · education · culture, language, religion or spirituality · significant extra-curricular activitiesParenting time refers to the time that the child spend in the care of one of their parents, whether or not the child is physically with the parent (for example, it includes times when children are in school). Parenting time may be set out in a schedule.Child support is the amount of money one parent pays to the other to support their child financially.Parent Information Session is an approximate three-hour informational online session that all people seeking Family Justice Services must complete prior to mediation services being offered. The online session is found at: https://www.supreme.courtcourses.ca/Name and Phone(Required) First Last Phone Your InformationFill in your information below.Privacy Check this box if you do not want your contact information to be shared with the other person. My Name:(Required) First Middle Last Last Name at Birth My Home Phone:My Cell Phone:My Email: Please note that if you provide your email address, FJS may attempt to contact you by email.My Date of Birth: Month Day Year My Occupation(s): My Mailing Address: Street Address P.O. Box OR Address line 2 City / Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Do you need an interpreter? Yes No Please note that FJS is not responsible for any interpreter fees or arrangements.If yes, state the language and dialect: Do you have a lawyer representing you in your family proceeding? Yes, I have a lawyer. No, I do not have a lawyer at this time. My Lawyer / Lawyer's Firm: Name My Lawyer's Phone:My Lawyer's Address check here to enter Lawyer's address Lawyer's Address: Street Address P.O. Box OR Address line 2 City / Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Other Person's InformationFill in the other person's information (to the best of your knowledge).Other Person's Name: First Middle Last Last Name at Birth Other Person's Home Phone:Other Person's Cell Phone:Other Person's Email: Please note that if an email address is provided, FJS may attempt to contact them by email.Other Person's Date of Birth: Month Day Year Other Person's Occupation(s): Other Person's Mailing Address: Street Address P.O. Box OR Address line 2 City / Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Does the other person need an Interpreter? Yes No Please note that FJS is not responsible for any interpreter fees or arrangements.If yes, state the language and dialect: Does the other person have a lawyer representing them in their family proceeding? Yes, the other person has a lawyer. no, the other person doesn't have a lawyer at this time. Other Person's Lawyer / Lawyer's Firm: Name Other Person's Lawyer's Phone:Lawyer's Address for Other Person check here to enter Lawyer's address for the Other Person Other Person's Lawyer's Address: Street Address P.O. Box OR Address line 2 City / Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Information About Your RelationshipRelationship status: choose one the following: The other person and I were married and are now separated. The other person and I were never married but lived together as a couple. The other person and I were never married and never lived together as a couple. Other Married on (date): Month Day Year Separated on (date): Month Day Year Started living together on (date): Month Day Year Stopped living together on (date): Month Day Year Relationship: otherEnter your relationship details if they do not fit the other choices above.Your Child(ren)'s InformationFill in the information for the child(ren) that this Request is made in relation to:Child (1) Name: First Middle Last Child (1) Date of Birth: Month Day Year Child (1) Mother's Name: First Middle Last Child (1) Father's Name: First Middle Last Child (1) Other Caregiver: First Middle Last Other Caregiver's relationship to Child (1):GrandmotherGrandfatherAuntUncleSisterBrotherMotherFatherCousinOtherChild (1) is Currently Living With:MotherFatherOther caregiver2nd Child Check this box to enter information for a 2nd child. Child (2) Name: First Middle Last Child (2) Date of Birth: Month Day Year Child (2) Mother's Name: First Middle Last Child (2) Father's Name: First Middle Last Child (2) Other Caregiver: First Middle Last Other Caregiver's Relationship to Child (2):GrandmotherGrandfatherAuntUncleSisterBrotherMotherFatherCousinOtherChild (2) is Currently Living With:MotherFatherOther caregiver3rd child Check here to enter information for a 3rd child Child (3) Name: First Middle Last Child (3) Date of Birth: Month Day Year Child (3) Mother's Name: First Middle Last Child (3) Father's Name: First Middle Last Child (3) Other Caregiver: First Middle Last Other Caregiver's Relationship to Child (3):GrandmotherGrandfatherAuntUncleSisterBrotherMotherFatherCousinOtherChild (3) is Currently Living With:MotherFatherOther caregiver4th child Check here to enter information for a 4th child. Child (4) Name: First Middle Last Child (4) Date of Birth: Month Day Year Child (4) Mother's Name: First Middle Last Child (4) Father's Name: First Middle Last Child (4) Other Caregiver: First Middle Last Other Caregiver Relationship to Child (4):GrandmotherGrandfatherAuntUncleSisterBrotherMotherFatherCousinOtherChild (4) is Currently Living With:MotherFatherOther caregiverMore than 4 Children Check this box if there are more than 4 children Additional ChildrenEnter information for the other children in the space provided.Has Child Protection Services ever been, or are currently involved with you, the other person, and the child(ren)? Yes No Court OrdersCourt orders include orders such as peace bonds, emergency protection orders (EPOs), undertakings, recognizances or probation orders.Are there any Court orders that impact your own contact or your child(ren)'s contact with the other person? Yes (You must attach a copy of the court order(s) to this Request for Service) No Attach Court order(s) impacting contact with the other person. Drop files here or Select files Accepted file types: bmp, doc, docx, gif, heic, jpg, jpeg, pdf, png, tif, tiff Maximum file size per form: 30 MBAre there any existing Court orders or written agreements for parenting and/or child support? Yes (You must attach a copy of the court order(s), and/or written agreement(s) to this Request for Service) No Attach Court order(s) and/or written agreement(s) for parenting and/or child support. Drop files here or Select files Accepted file types: bmp, doc, docx, gif, heic, jpg, jpeg, pdf, png, tif, tiff Maximum file size per form: 30 MBParentingIf you are making a Request for Service in relation to a parenting issue, please fill in the information below:Parenting - Current ArrangementsPlease answer the following questions regarding parenting arrangements currently in place.What is the current parenting schedule for your child(ren) (daily, weekly, monthly or other)?What are the current arrangements for making major decisions about the child(ren)?Parenting - Proposed ArrangementsPlease answer the following questions to propose new or changes to the parenting arrangements.What kind of parenting schedule would you like for your child(ren) (daily, weekly, monthly or other)?How would you like major decisions to be made about the child(ren)?Child SupportPlease select one or more of the following and enter details in the space provided below: I am requesting the basic table amount of child support as per the Child Support Guidelines. I am requesting special and/or extraordinary expenses. I am requesting an amount of child support that is different from the Child Support Guidelines basic table amount. I am requesting retroactive child support. Special and/or extraordinary expenses:Amount of child support that is different from the Child Support Guidelines basic table amount:Retroactive child support:If you are making a Request for Service in relation to a child support issue, you must provide income information from all of your income sources. Attach a copy of the following applicable information with this Request for Service:Attachment(s) to this Request for Service: Current income information / statement of income (i.e.: statement from your employer confirming your year-to-date earnings, overtime, and rate of annual pay) Copies of your personal Income Tax Return and copies of your Notice of Assessment (and any Notices of Reassessment) for each of the 3 most recent taxation years OR Proof of Income Statements ("Option C" or "Income and Deduction" printouts) from the Canadian Revenue Agency (CRA) for the 3 most recent taxation years.Note: If you do not have copies of your Return/Notice of Assessment, you may print your "Option C" printouts online or contact the CRA at 1-800-267-6999 or 1-800-959-8281 to have your "Option C" printouts sent to you. Income information from other sources not listed above (eg: Employment Insurance (EI), Workers' Compensation, Income Support, etc.) Provide details in the space provided below. Information / supporting documentation for special or extraordinary expenses if you are seeking those expenses. I am unable to attach all files at this time and will provide files at a later date. IMPORTANT: If not attaching all documents to this request, you must agree to forward your documents to the FJS office within 14 days of being contacted. Address: Family Justice Services143 Main StreetStephenville, NLA2N 1J5 Details about Income information from other sources:Attach income information file(s) Drop files here or Select files Accepted file types: bmp, doc, docx, gif, heic, jpg, jpeg, pdf, png, tif, tiff Maximum total file(s) size per form: 30 MBSignature and DateThe information I have provided in this Request for Service is the truth to the best of my knowledge and belief. I have read and I understand the following requirements: · I must attend a Parent Information Session. This session will provide information on Family Justice Services, the legal and emotional separation process, and the needs of children following a separation. · I can only use FJS mediation services if both me and the other person have submitted a completed Request for Service Form with all relevant attachments to the Request form. I must attach any previous or existing court orders or written agreements for parenting or child support. · I must provide the other person with the link to the Request for Service Form [https://court.nl.ca/forms/supreme/family-justice-services-request-for-service/]. I will contact FJS if I cannot provide the link to the other person(s). (Tick the box below to request a blank physical copy if needed to provide them). · My financial information may be shared with the other person.Request to be mailed a blank physical copy of the Request for Service Form Yes, please send me a blank physical copy of the Request for Service Form for me to provide to the other person(s). Agreement to share my attached financial information Yes, I agree that my attached financial information can be shared with the other person(s) Date(Required) Month Day Year Print your name here(Required) SignatureTo sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.Upon submitting a completed electronic Request for Service from yourself and the other person, a Family Justice Services Mediator will contact you via mail to offer an Intake Appointment. If we do not receive both completed electronic Request for Service forms within 30 days of each other, there will be no services offered, and we will notify you at that time. If you have any questions as to the status of your electronic Request for Service Form, please call: 709-643-8396PhoneThis field is for validation purposes and should be left unchanged.
