Party’s Full Legal Name

Private Counsel (Name, address, & telephone number)Duty Counsel

Party’s address & telephone number

Party’s Full Legal Name

Private Counsel (Name, address and telephone number)Duty Counsel

Party’s address & telephone number

Applicant’s Signature

Counsel for Applicant

Duty CounselWitness

Respondent’s Signature

Counsel for Respondent

Duty CounselWitness

Signature & Printed Name

York Region, Authorized Family Support Worker Ministry of Community & Social Services, Counsel Children’s LawyerOther

Superior Court of Justice, Family Court Minutes of Settlement50 Eagle Street West, Newmarket, Ontario L3Y 6B1

Number on Docket Court File Number

APPLICANT:

RESPONDENT:

SUBJECT TO THE COURT'S APPROVAL, THE PARTIES CONSENT TO AN ORDER ON THE TERMS FOUND ON THE ATTACHED PAGE(S):

CHILDREN (Set out details of any child affected by the proposed order).Full legal name Date of birth

Full legal name Date of birth

Full legal name Date of birth

Full legal name Date of birth

Full legal name Date of birth

THE PARTIES TO THIS AGREEMENT ACKNOWLEDGE THE FOLLOWING:

1. They have had independent legal advice before signing it or, in the alternative, have been advised that they have the right to consult a lawyer before signing this agreement.

2. They are signing this agreement voluntarily and without fear, threats, compulsion or influence from the opposing party or any other person.

3. The terms of this agreement will be incorporated into an order of the court which can be enforced by the court in the event of default. Note: If you wish to enforce the order, you must prepare a formal order and file it with the court.

4. Any order of the court for custody, access or support may be changed by the court if a change in circumstances occurs in accordance with the applicable Act under which the order is made and the Family Law Rules.

NOTE: Attach the pages with initialed clauses for inclusion in the order of the Court.

Signed at Newmarket, York Region, Ontario, on ,20 .

Revised: March 2009 PAGE OF

Custody and Access Clauses(Only clauses initialed by both parties will be included in the order)

PATERNITY TESTING

1. A RThe parties and child (Name of child) shall have leave to obtain DNAtests to determine if the Applicant Respondent is the biological father of thesaid child. The cost for the tests shall be paid fully by the Applicant Respondent subject to reapportionment of the costs on motion once the results are obtained.

VARIATIONS

2. A R

The custody access provisions at paragraph(s) of the order made by Justice of this Honourable Court,

the (Name of court) at (Place),

made on , (Date) shall be changed as set out below:

CUSTODY

3. A R

Temporary FinalCustodyof the child(ren) named on page 1 of this agreementof the following child(ren) , shall be to theApplicant Respondent Applicant and Respondent jointly

and the child(ren)’s primary residence shall be with theApplicant Respondent Applicant and Respondent equally

4. A R The Applicant and the Respondent shall consult with each other before making any major decision relating to the child(ren)’s health, education and/or general welfare.

Other:

A R

5. Other:

Other:

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VISITATION (ACCESS)

6. A R

Temporary Finalvisitation (access) with the child(ren) named above shall be to the

Respondent Applicant.The terms of access are: reasonable access upon reasonable notice.

See attached schedule as follows: as per sub-clauses below. Other:

(a) A R

Except as otherwise provided herein, weekend visitation (access) shall take place from Friday Saturday Sunday at (Time) p.m. a.m. until Saturday Sunday Monday at (Time) p.m. a.m. and shall occur every alternate weekend commencing on (Date)

The visit shall be extended by one day if the child(ren) is/are not required to attend school on the Friday before or the Monday after the scheduled weekend visit (access).

Other:

(b) A R

Except as otherwise provided herein, a mid-week visit each week which shall occur,from (Day of week) until (Day of week)

at (Time) p.m. a.m. at (Time) p.m. a.m.

commencing on , . andfrom (Day of week) until (Day of week)

at (Time) p.m. a.m. at (Time) p.m. a.m.

commencing on , .

(c) A R

(Number) weeks of vacation with the child(ren) during the July/August summer school break period which may may not be exercised consecutively. The visiting party shall notify the other party of his/her choice of weeks by (Date) of each year.

Other:

(d) A R

Christmas:

(e) A R

March School Break:

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(f) A R

Every Mother’s Day Father’s Day regardless of the weekend access schedule, from a.m. (Time) to p.m. (Time).The other party shall have the same rights in relation to this day on the same terms.

(g) A R

Other:

(h) A R

Other:

(i) A R

Unlimited telephone accessReasonable telephone access as follows:

Telephone calls shall not be made before a.m., or after p.m.

(j) A R

Such further and other visitation (access) as agreed to by the parties.

7. A R

Exchanges for access shall take place at the home of the party with primary residence of the child(ren) Other (specify)

8. A R

The party exercising access is responsible for the child(ren)’s transportation to and from all scheduled visits (access).

Other (specify)

9. A R

Visitation (access) shall be supervised by the agency or person(s) named below pending further order of the court or written agreement between the parties.

York Region Supervised Access Centre in the following persons:

The date(s) and time(s) for the visits shall be arranged between the parties and the person(s)/agency supervising the visit.

Other (specify): .

The parties shall complete the agency’s intake procedures forthwith.Each of the parties shall pay the agency costs for visitation directly to the agency orOther

10. A R

Each of the parties shall have the right to consult directly with, and obtain the requested information, from the child(ren)’s schools, teachers, doctors, dentists, and any other care professional about the health, education and/or general welfare of the child(ren), and this shall be good and sufficient authority for all care professionals.

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11. A R

The parties shall keep each other informed as to their addresses and telephone number(s), and he/she shall notify the other party forthwith upon any intended change.

12. A R

The parties shall convey all necessary information about the child(ren) to each other by means of a communication book which shall travel with the child(ren).

13. A R

Other:

14. A R

Neither party shall speak disrespectfully about the other party, discussing the court case or any other adult issue in the child(ren)’s presence, and each of the parties shall make his/her best effort to deter other persons from speaking disrespectfully about the other party, discussing the court case or any other adult in the child(ren)’s presence.

15. A R

Other:

16. A R

Other:

CHILDRE N’S LAWY ER

17. A R

Subject to the approval of the court, the parties request the appointment of the Office of the Children’s Lawyer (OCL) to determine the views and preferences of the child(ren) in relation to the issues of custody and/or access. The parties shall each complete the OCL’s intake form promptly and forward the form to the OCL within 10 days of the date the parties sign this agreement.(Draft OCL Order to be prepared by the parties and given to judge for signature)

MOBILITY RIGHTS

18. A R

The Applicant Respondent shall provide to the other party with at least days written notice in advance of any planned change of residence from

outside of more than (Distance) from (Place).Either party may apply to the court for a judicial determination if the parties are unable to agree on the planned change of residence for the child(ren).

19. A R Neither party shall travel with the child(ren) outside of the Province of Ontario without the prior written consent of the other party, which consent shall not be unreasonably withheld.

20. A R Other:

21. A R Other:

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Support Clauses(Only clauses initialed by both parties will be included in the order)

VARIATION

1. A R The child support provisions at paragraph(s) of the order of Justice (Name) of this Honourable Court

the (Name of court) (Place)made on , (Date) shall be changed as set out below:

CHILD SUPPORT

2. A R Commencing on , (Date) and on the day of every month thereafter, the

Respondent Applicant (also referred to as “Payor”)shall pay to the

Applicant Respondent (also referred to as “Recipient”)temporary final

child support for the benefit ofall (Number of children) child(ren) named at page 1 of this agreement the following (Number of children) child(ren)

(Name(s) & DOB)in the amount of $ _ .00 , per month

The support order is in accordance with the Child Support Guidelines, in that the annual gross income of the Payor is $ _ .0 0 , and the table amount of child support under the Guidelines for (Number) child(ren) is $ .00 per month.

The temporary child support order is agreed to by the parties on a without prejudice basis, and the Payor shall verify his/her income on the terms provided in this agreement.

3. A R The parties have agreed to an amount of support that is lower than the support payable under the Child Support Guidelines for the following reason(s):_

S. 7 EXPENSES 4. A R In addition to the child support payable above, the Payor shall pay to the

Recipient additional child support in the amount of $ .0 0 , per month on atemporary final basis effective from , (Date),

representing his/her proportionate share of the special or extraordinary expenses of the (Number) child(ren) named above. The additional support payable is based on the following facts which the parties acknowledge are accurate.

The Payor’s annual gross income is $ .00 The Recipient’s annual gross income is $ .00The Payor’s percentage share of the combined income is _%The Recipient has the following special or extraordinary expenses for the child(ren):

Monthly AmountChildcare (daycare) Expenses $Medical and Dental Expenses $ .00Education (including post-secondary) Expenses $ Extracurricular Expenses $Total Special or Extraordinary Expenses $

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The Respondent Applicant shall pay spousal support tothe Applicant Respondent on a

5. A R [For the information of the parties] The above obligation to pay child support as set out above may be changed by further written agreement between the parties and filed with the court, and either party may apply to the court for an order to reduce, increase or terminate child support payable. Independent Legal Advice is recommended.

6. A R The Payor shall maintain extended medical and dental coverage for the (Number) child(ren) named at page 1 of this agreement,The following (Number) child(ren)

(Name(s)/DOB),and

the Recipient,that is available through his/her workplace. This obligation shall remain in full force and effect for so long as the benefit remain available to the Payor and the child(ren) remain eligible for child support.

7. A R The Payor Recipient shall make financial disclosure of his/her income by (Month/Day) of each year commencing in (Year), by delivering tothe other party copies of his/her income tax return, including all T forms, schedules and attachments, notice of assessment/reassessment, and a year-to-date gross income statement.

8. A R Other:

9. A R Other:

SPOUSAL SUPPORT

10. A R

temporary final basis in the amount of $ .00 per month, commencing on , (Date), and on the day of every month thereafter for so long as spousal support is payable.

The applicant and the respondent agree that the order to pay spousal support shall terminate the earliest of , (Date), or on a specified event occurring as may be set out below under the heading: Support (Other)

Spousal support shall be increased annually on the order’s anniversary date by the indexing factor as defined in s.34(6) of the Family Law Act.

[For the information of the parties] The above obligation to pay spousal support may be changed by further written agreement between the parties and filed with the court, and either party may apply to the court to reduce, increase or terminate spousal support. Independent Legal Advice is recommended.

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SUPPORT ARREARS

11. A R The arrears of child support spousal support are fixed in the total amount of$ . 0 0 , effective , (Date). Of the total fixed amount,

the amount of $ .00 is owed to ; the amount of $ .00 is owed to ; the amount of $ .00 is owed to .

The Applicant Respondent shall pay the arrears owed to

in the amount of $ .0 0 , per month, and the arrears owed to

in the amount of $ .0 0 , per month, and the arrears owed to

in the amount of $ .0 0 , per month,

commencing on , (Date) and on the day of every month thereafter until the arrears have been paid in full.

SUPPORT (OTHER)12. A R Other:

Other:

SUPP ORT ENFORCE MENT13. [Automatic] Unless the support order is withdrawn from the Family Responsibility Office, it shall

be enforced by the Director, and all amounts owing under the order shall be paid tothe Director, who shall pay them to the person to whom they are owed. A support deduction order shall issue.

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Disclosure Clauses(Only clauses initialed by both parties will be included in the order)

DISCLOSURE

1. A R

The Applicant Respondent shall serve the specified documents below on the Applicant Respondent York Region Other and file them with the Court on the 1st Floor of the Courthouse

at the latest, by 2:00pm, two days before the next hearing date. within days of the next hearing date.by , (Date)

(a) A R

An up-to-date sworn Financial Statement (Court Form 13 - Support issues only);

(b) A R

Income Tax Returns, including all T Forms, Schedules and other attachments, Notices of Assessments/Reassessments for the year(s)

(c) A R

Year-to-date proof of total gross income from all sources, by consecutive pay statements, year-to-date pay/income statement, or employment letter with details of terms of employment, rate of pay, hours per week, total overtime and rate paid.

(d) A R

Bank statements for all accounts over which he/she has signing authority covering the period from , (Date) to the current date.

(e) A R

Copies of all credit applications from , (Date) to the current date.

(f) A R

A job search record/report of all companies that he/she has applied to since , (Date).

(g) A R

A medical letter/report from his/her physician detailing the reasons why he/she has been unable to work since , , and a prognosis report.

(h) A R

Business records for his/her company (Name) for the time period from , (Date) to , (Date), including year end financial statements, income and expense statements, profit and loss statement, list of assets, liabilities and debts.

(i) A R A copy of his/her Record of Employment from_ (Name of company

(j) A R Other:

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Procedural and Other Clauses(Only clauses initialed by both parties will be included in the order)

PROCEDURAL ISSUES

1. A R

The Applicant Respondent consents to the late service and filing of the other party’s responding materials until two days before the next court date by 2:00pm or by , (Date).

2. A R

The Applicant Respondent consents to the other party amending his/her pleadings to add the further claim(s) of .

3. A R

OTHE R ISS UES

The Applicant Respondent waives his/her right to approve the draft order as to form and content.

4. A R

Other:

5. A R

See attached schedule titled for incorporation into a temporary final order of the court.

6. A R

The parties agree that their property has been divided to their mutual satisfaction.

7. A R

The parties agree that the temporary restraining order made by Justice (Name) of this Honourable Court on , (Date)

shall continue in full force and effect on a without prejudice basis until the return hearing date of the motion.

shall be terminated effective , (Specify date).

8. A R

Any money owing under this order, including costs to be assessed or costs fixed by the court, bears interest at the postjudgment interest rate calculated from the date of the order, and where the order provides for periodic payments, each payment in default bears interest only from the date of default.

ADJOURNMENT:

9. A R The matter(s) of Custody Access Table Child Support s.7 Expenses Retroactive support Support Arrears Spousal Support Property Restraining Order Other (Specify)

is/are adjourned to , (Date) at a.m/p.m.; or to a date to be fixed by the parties through the Trial Coordinator’s Office.

The next scheduled hearing date is for aFirst Appearance Case Conference Settlement ConferenceMotion Trial Management Conference

Note: Court Forms and the deadline dates for service and filing of all forms and documents are available in the Family Law Information Centre (FLIC) on the 2nd floor of the Courthouse.

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