Acknowledgment - Information from a Family Counsellor or Family Dispute Resolution Practitioner
Family Law Act 1975 - s60J(1)	
This form is used by the person applying for a Part VII order where it is alleged that there has been abuse of a child by one of the parties to the proceedings or there has been family violence towards the child or a member of the child’s family by one of the parties to the proceedings.
This form is not filed but is provided to the Judicial Officer hearing the case when you first appear in Court.
YOU DO NOT NEED TO USE THIS FORM if you are able to satisfy the Court that there are reasonable grounds to believe that:
(a)	there would be a risk of abuse of the child if there were to be a delay in applying for the order; or
(b)	there is a risk of family violence by one of the parties to the proceedings.	
Part A	About the parties	

APPLICANT 1
Family name as used now	
RESPONDENT 1
Family name as used now	
     		     	
Given names	Given names	
     		     	

APPLICANT 2
Family name as used now	
RESPONDENT 2
Family name as used now	
     		     	
Given names	Given names	
     		     	

Part B	Acknowledgment	

I,      	
            FULL NAME
have received information from a Family Counsellor or Family Dispute Resolution Practitioner about the services and options (including alternatives to court action) available in circumstances of abuse or violence.
	
Part C	Signature 	
	
Signature 	

Place      	Date    /   /    	

ADVICE TO APPLICANT

File No:      	

Your Request
You applied to file your application documents without those documents being accompanied by a certificate from a Family Dispute Resolution Practitioner. Your request to file your documents without that certificate has been granted.
What’s Next?
However, based upon the information which you have provided, you may need to consult a Family Counsellor or Family Dispute Resolution Practitioner to obtain information about the services and options (including alternatives to court action) available in circumstances of abuse or family violence. Refer to s 60J of the Family Law Act 1975 for more information. Having obtained this information, you should complete a written acknowledgment of having received this information and bring it with you on the first day you come to court.  You can use the acknowledgment on page 1.

This does not mean that you must attend family dispute resolution or make endeavours to do so. All that you are required to do is obtain information about services and options that are available other than court action, in the circumstances of abuse or family violence.

If you do not obtain the information and complete the written acknowledgement, then the Judicial Officer may not hear your case on the first Court date and your case may be adjourned until you obtain the information and lodge the written acknowledgment with the Court. The presiding Judicial Officer or Registrar will decide what should happen. 
Where do I go?
The information you need can be provided by a Family Counsellor or a Family Dispute Resolution Practitioner. Information on where to locate family dispute resolution practitioners can be found on a Federal Government website www.familyrelationships.gov.au.

You may also call the Family Relationships Advice Line on 1800 050 321 and ask to speak to a Family Counsellor or a Family Dispute Resolution Practitioner to obtain information about the services and options (including alternatives to court action) available in the circumstances of abuse and violence. 
Any Questions?
If you have any questions, read the brochure entitled “Compulsory Family Dispute Resolution” available at www.familyrelationships.gov.au. 

If you have any more questions:

•	If you are legally represented, consult your lawyer;
•	Contact the Family Relationships Advice Line on 1800 050 321;
•	Contact a registered Family Counsellor or Family Resolution Dispute Practitioner;
•	Contact the legal aid office in your State or Territory who may be able to provide you with general information.

Authorised by the Chief Justice/Chief Judge pursuant to Rule 15.21 		0921V1