Provide a statement in support of your application for a special guardianship order
| Published date | 21 March 2018 |
| Subject Matter | Children Act forms |
Name of court
Case no.
Date issued
Supplement for an
application for a
Special Guardianship Order
Section 14A Children Act 1989
Full name(s) of the child(ren) Child(ren’s) number(s)
C13A Supplement for an application for a Special Guardianship Order (04.14) © Crown copyright 2014
1. Your relationship to the child(ren)
State whether
• you are a guardian
• you are a person in whose favour a child arrangements order (order determining with whom a child should live
and when) is in force (Section 14A (5)(b))
• you are a person with whom the child has lived for 3 out of the last 5 years
• you are a person who:
• if a child arrangements order is in force, has the consent of every person in whose
favour the order was made
• if the child is in the care of the local authority, the consent of that authority
• in any other case, has the consent of every person with parental responsibility
• you are a local authority foster parent or relative with whom the child has lived for a period of at least one year
immediately preceding the application (Section 14A(5)(d) and (e))
• you are applying to the court for permission to make this application; or
• the court gave permission for you to apply for a special guardianship order. In this case please state the name
of the court and the date of the order.
2. Notication to the Local Authority
Please state below the name of the local authority (if the child is looked after by a local authority, give details of
that authority otherwise give the details of the local authority where you normally live). Give the date on which you
notied them of your intention to make an application to the court for a special guardianship order (Section 14A(7)).
If you notied the local authority less than three months before making this application please state whether an
application to adopt the child named above has been made; the name of the court in which the application is
proceeding and, where known, the court case number.
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