Government of Ontario: Child and Family Services Review Board

Request for Review of Children's Aid Society
Child and Family Services Review Board Application
Child and Family Services Act - Section 68

IMPORTANT NOTICE

Please read the following information before completing this application form.

You may make a complaint about a children's aid society to the Child and Family Services Review Board

• once you have completed the children's aid society's internal complaint review procedure; or
• at any time during the children's aid society's internal complaint review procedure; or
• directly without going through the children's aid society's internal complaint review procedure

if you believe:

1. that the children's aid society has refused to proceed with your complaint;
2. that the children's aid society has failed to respond to your complaint within the timeframes required by regulation;
3. that the children's aid society has failed to comply with the complaint review procedure or with any other procedural requirement under the Child and Family Services Act relating to the review of complaints;
4. that the children's aid society has failed to comply with clause 2(2)(a) of the Child and Family Services Act which states, "Service providers shall ensure that children and their parents have an opportunity where appropriate to be heard and represented when decisions affecting their interests are made and to be heard when they have concerns about the services they are receiving;"
5. that the children's aid society has failed to provide you with reasons for a decision and this affects your interests;
6. that the children's aid society has inaccurately recorded something on your file or record and this has not been resolved through the children's aid society's internal complaint review procedure*;
   
   *Note:  This complaint can only be made to the Child and Family Services Review Board after it has been reviewed through the children's aid society's internal complaint review procedure.

The Child and Family Services Review Board cannot review a complaint if the complaint is about:

1. an issue that has been decided by the court or is before the court; or
2. an issue that falls under another decision-making process under the Child and Family Services Act or the Labour Relations Act.

Instructions

1. Please complete all fields as specified;
2. Sign and date form at the bottom;
3. Fax or mail or deliver the form to the address below:
   Social Justice Tribunals Ontario
   Child and Family Services Review Board
   1075 Bay Street, 7^th Floor
   Toronto ON  M5S 2B1
   Telephone: 416 327-4673 or Toll Free: 1 888 728-8823
   Fax to: 416 327-0558

1. General Information

Last Name
First Name
Address (Number and Street)
Suite/Unit/Apt.     City/Town
Province     Postal Code

2. Child Information

Child's Last Name
First Name
Middle Name
Child's Date of Birth (yyyy/mm/dd)
Child's Band or Native Community (if applicable)

Please use the space below to explain your complaint in detail. Be as specific as possible. Attach additional pages if necessary.

4. Which children's aid society is involved in your complaint?

Children's Aid Society Name
Children's Aid Society Address (Number and Street)
Suite/Unit/Apt.     City/Town
Province     Postal Code

8. If your application is eligible for review by the Child and Family Services Review Board, a hearing may be held.
Will you need any of the following services at a hearing?

• Interpreter No  Yes     Language
  Dialect
  
• Sign Language Interpreter No    Yes
  
• Wheelchair Access No    Yes
  
• Other (Please specify)
  

9. Signature of Applicant (Note: This form must be signed)

Signature

Date (yyyy/mm/dd)

Notice Regarding the Collection of Personal Information
(Freedom of Information and Protection of Privacy Act)

The Child and Family Services Review Board collects the personal information requested on this form for the purpose of conducting a review, under the legal authority of Section 68 of the Child and Family Services Act. It could be shared with participants if a hearing is held. If you have any questions, please contact a Case Coordinator with the Child and Family Services Review Board at 416 327-4673.

The Child and Family Services Review Board does not have the authority to review all children's aid society decisions. The Child and Family Services Review Board will advise you in writing of the reasons if your application cannot be reviewed.

FOR OFFICE USE ONLY

File Number
Date Application Received by the CFSRB