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Family Court Support Program Intake Form

The Family Court Support Program is a free program through the Ministry of Children, Community & Social Services to support clients that have experienced domestic violence or abuse who are thinking about or currently going through the Family Court Process. The Family Court Support Worker is not a lawyer and therefore cannot provide legal advice but can provide legal information. The program offers emotional support, help in understanding the court process and forms, safety planning and more.

We are asking you for some personal information to better understand who we serve and what the needs are. The information will be kept confidential and only used to better understand your situation and how we can improve our services. If you have any questions or concerns about why we ask this information, please let us know.

Fields marked with * are mandatory.







    Children Information

    Child #1

    Child #2

    Child #3

    Child #4

    Your Partner/Ex-Partner

    Confidentiality Agreement

    I understand that any and all information that I choose to share with Anova will be kept private and confidential and will not be shared with anyone without my written consent, with the following exceptions:

    • If Anova has reason to believe that I am going to hurt myself or someone else, Anova has an obligation to call the London Police and connect me with the support I need.
    • If Anova has reason to believe that a child under the age of sixteen is being abused or is at risk of being abused (including emotional harm which can be caused by witnessing domestic violence), Anova has a duty to report the information to the Children’s Aid Society.
    • If the court requests a copy of your file, Anova is obligated to provide them with a copy of the entire file or any part that they wish to have. Anova can also be asked to testify in your case.

    I understand and agree*

    I understand that the Family Court Support Worker Program provides general information and support only. The Family Court Support Worker Program is not intended to be, and should not be taken, as legal advice.

    I understand and agree*