Supreme Court Rules 1937—Form 3.1
(see o 76 r 3)
Application for adoption order

In the Supreme Court of the Australian Capital Territory

No		of (year)

Adoption Act 1993

In the adoption of (full name to be given to the child)
Application is hereby made to the Court [*by/*on behalf of] the proposed adoptive parents mentioned below for the adoption of the child mentioned below.

Particulars of proposed adoptive parent(s)
	Adoptive father	Adoptive mother	
Full name:
Occupation:
Address:
Date of birth:
Relationship (if any) to the child:			
Particulars of the child proposed to be adopted
Full name in which the birth of the child is registered:
Sex:
Date of birth:
Place of birth:
Father’s full name:
Mother’s full maiden name:  
Mother’s full name at the date of birth of the child:  
This application is made—
personally by the proposed adoptive parent(s).
on behalf of the proposed adoptive parents by [name(s)], solicitor(s).
by the chief executive responsible for adoption.
by [full name], principal officer of [name], a private adoption agency.
Date:
Signature:
Address for service:
*Strike out where inapplicable.
Note	If the name of a birth parent of the child to be adopted is unknown to the proposed adoptive parent(s), care should be taken to ensure that this information is not disclosed to the proposed adoptive parent(s) in filling out this form. In such a case, if practicable, this form should be filled out and signed by the solicitor(s) for the proposed adoptive parent(s), by the chief executive responsible for adoption or by the principal officer of the relevant adoption agency (as appropriate).

Endnote
1	This form was originally in the Supreme Court Rules 1937.  Under the Court Procedures Act 2004 A2004-59, pt 8, the form became a form approved under that Act. 

©  Australian Capital Territory 2005