form 1 - initiating application - Family Court of Western Australia

Part DChildren(If more than four children, add a page with the same details)17 Family name18 Given names19 Date of birth(day / month / year)Child 1 Child 2/ / / /20 Gender male female male female21 Child lives with22 Family name23 Given names24 Date of birth(day / month / year)Child 3 Child 4/ / / /25 Gender male female male female26 Child lives withPart ESafety concerns27 Is there a current RestrainingOrder between you and/or theother party or the children?NoYesIf yes, who is restrained?28 Are you concerned aboutyour safety while attendingCourt?NoYesPage 4 of 6