New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter A - Forms Authorized by Section 205.7 › Child Protective Forms (Family Court Act Article 10) › Form 10-29a - Application for order for access to child(ren) and/or home-before petition filed

Current through Register Vol. 46, No. 28, July
					 10, 2024
F.C.A. § 1034(2) Form 10-29a
(Child Protective-Application for
Order for Access to Child(ren)
						and/or
Home-Before Petition Filed)
(9/2006)
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of Docket No.
A Child(ren) Under the Age of
						Eighteen
Alleged to be APPLICATION FOR
Abused or Neglected by ORDER FOR ACCESS
						TO
CHILD(REN) AND/OR HOME-
Before Petition Filed
Respondent(s)
________
TO THE FAMILY COURT:
I, [specify name]:, having been duly
						sworn, state the following:
1. I am [specify job title, agency and
						county]:
2. (Upon information and belief,) the
						child(ren) who are the subject(s) of this application is/are: Name Sex Date of
						Birth Custodial Parent/Guardian Child's Address
[Select Paragraph 3(a) OR 3(b) and check
						applicable boxes]:
3. a. Based upon the report of suspected
						child abuse or maltreatment, dated [specify]: and my subsequent investigation,
						I have reasonable cause to suspect that the life or health of the following
						child(ren) [specify]: may be in danger. However, I have been unable to locate
						the above-named child or other children in the household; or On [specify
						date]:, I visited the child(ren)'s home at the address set forth in ¶; 1,
						but was denied access to the child(ren) sufficient to determine his/her/their
						safety;
b. Based upon the report of suspected
						child abuse or maltreatment, dated [specify]: and my subsequent investigation,
						I have probable cause to believe that an abused or neglected child or children
						may be located at the address set forth in ¶; 1, but on [specify
						date]:
I visited the child(ren)'s home at that
						address, but was denied access to the home to investigate;
4. On [specify date]: I advised [specify
						parent or other person legally responsible]: that, if access to the child
						and/or home, as applicable above, was denied, I may seek an immediate court
						order for such access;
Form 10-29a Page 2
5. [REQUIRED if application is made when
						the Family Court is not in session or if it is later than the Family Court's
						deadline for new applications]: I would like to contact the Family Court judge
						by telephone. I can be reached at [specify telephone number]:
I am able to receive the Court's order at
						[specify e-mail and/or fax number]:
6. No previous application has been made
						to any court or judge for the relief requested herein (except [specify]:
						).
WHEREFORE, for the reasons stated above, I
						am requesting that the Family Court issue an order [check applicable
						box(es)]:
[Applicable where paragraph 3(a) was
						selected]:
requiring the parent or other person
						legally responsible to bring the following child or children [specify
						names]:
immediately at any hour between the hours
						of 6 AM and 9 PM for observation and interviews outside the presence of the
						parent or other person legally responsible:
to the following Child Advocacy Center
						[specify name and address]:
to the following person for an interview
						and observation [specify name and address of interview/observation
						location]:
to the Petitioner/Applicant for an
						interview and observation as follows [specify, including address of
						interview/observation]:
OR
[Applicable where paragraph 3(b) was
						selected]:
requiring the parent or other person
						legally responsible to permit me to enter the home immediately at any hour
						between the hours of 6 AM and 9 PM, in order to:
determine whether an abused or neglected
						child or children is/are present;
conduct a home study to evaluate the home
						environment of the child or children;
Dated:
______________
Signature of Applicant
______________
Print Name
______________
Title, Agency and County
Sworn to before me this day of ,
________
(Deputy) Clerk of the Court
Notary Public