District No.

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

.......... Applicant

of ...........

.......... Respondent

of .........

WHEREAS from information sworn before me to-day *by *on behalf of the above-named applicant under section 46 (3) of the above-mentioned Act it appears that the above-named child, being in the care of the .......... Health Board, was on the ... day of ....... 19..., without lawful authority,

*(removed from the custody of the board.)

*(removed from the custody of .......... of ............ who was taking care of the child on behalf of the board.)

*prevented from returning to the custody *(of the board) *(of ......... of ............ who was taking care of the child on behalf of the board) at the end of a period of leave.]

AND WHEREAS it further appears that you, the above-named respondent, *residing *for the time being at ......... in the said court district, can produce the said child,

THIS IS TO COMMAND YOU, the respondent, to appear at the sitting of the District

Court to be held at .......... on the ... day of ...... 19.... at .... a.m./p.m. on the hearing of the application made in the said information for an order directing you to deliver up the child to the custody of the board.

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

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

Judge of the Children Court

*(assigned to the said district)

To ...........

of ............

the above-named respondent

* Delete words inapplicable