District No.

In the matter of ....... a child

.............. Applicant

of .........

......... Respondent

of .........

WHEREAS ON APPLICATION the above-named health board, made under section 18 (1) of the above-mentioned Act THE COURT on the ... day of ...... 19.... MADE A CARE ORDER committing the above-named child, to the care of the board for the period from the ... day of ...... 19.... until the ... day of ...... 19.....,

NOW, THE COURT on the application of the applicant herein to have that order discharged and a supervision order made in respect of the child under section 22 (c) of the Act,

being satisfied that notice of the application herein was duly served

having heard the evidence tendered,

being satisfied that—

such order should no longer remain in force, but that

it is desirable that the child be visited periodically in his/her home by or on behalf of

the health board and

HAVING DISCHARGED the said care order in respect of the said child

HEREBY AUTHORISES the ......... Health Board to have the said child ........ visited in his/her home at ......... in the said court district on such periodic occasions as the board may consider necessary in order to satisfy itself as to the welfare of the child and to give to *(his/her parents) *(the person acting in loco parentis) any necessary advice as to the care of the child.

*[AND DIRECTS under section 19 (4) of the Act (as to the care of the child) as follows:—

this order shall remain in force—

*(for the period of twelve months from the date hereof)

*(from the ... day of ...... 19.... until the ... day of ..... 19...)

unless sooner discharged and, in any event, shall cease to have effect when the person in respect of whom it is made ceases to be a child.

Dated this ... day of ....... 19...

Signed ..................

Judge of the Children Court

* Delete words inapplicable