Name of matter:
		
Court file number/s	 	
Legal representation (please list for all parties)	Director/General:
Mother:
Father:
Children’s Representative:
Other:	
Listing hearing date

WITNESSES REQUIRED
	
Name of witness	Party calling	Party requiring for cross examination, if any	

			

			

			

SPECIAL ARRNGEMENTS (please tick)

	Yes 	No	
Remote witness room/video conferencing link			
Audio visual facilities 			
Telephone witness			
Interpreter			

ISSUES IN DISPUTE:

HEARING TIME REQUIRED

________________________________________________________________________

SIGNED BY PARTIES (please print name and organisation and sign)

1.	__________________________________________________________________
NAME			ORGANISATION			SIGNATURE		
2.	__________________________________________________________________
NAME			ORGANISATION			SIGNATURE

3.	__________________________________________________________________
NAME			ORGANISATION			SIGNATURE

4.	__________________________________________________________________
NAME			ORGANISATION			SIGNATURE