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First Name
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Last Name
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DOB
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Province
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Northwest Territories
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Quebec
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Gender
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Female
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Agender
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Current Parenting Plan
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Alternating Weekends and One Evening Per Week with One Parent, Rest with the Other Parent
Alternating Weekends and One Overnight Per Week with One Parent, Rest of Time with the Other Parent
Residence with One Parent, Supervised Weekend Time with the Other Parent
Shared Equal Time: Alternating Weeks
Shared Equal Time: Split Two-Week (2-2-3-2-2-3) Rotation – 2 week cycle
Shared Equal Time: Split-Week (2-2-5-5) Rotation - 2 week cycle
Primary address
Other supervising parties (i.e. School, Grandparent, Friend, Relative)
Emergency Contact Name
Emergency Contact Number
Health Card
Family Physician
Picture
Max. file size: 32 MB.
