Name (if known) or description

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

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

................. Respondent

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

WHEREAS ON APPLICATION by the ........ Health Board, made under section *12 (4) *13 (1) of the above-mentioned Act, the Court on the ...... day of .......... 19.... made an emergency care order placing the child *named

*described above, under the care of that health board for the period of ........ days,

AND WHEREAS THE COURT *(on the ...... day of ........... 19.... on the application of . ......... of ...........) gave directions in relation to ..........

the said child under section 13 (7) (a) of the Act,

NOW, THE COURT on the application of the applicant herein under section 13 (7) (b) of the Act to have the direction with respect to—

*varied *discharged,

being satisfied that notice of the application was duly served,

having heard the evidence tendered, and

being satisfied that the welfare of the child so requires,

HEREBY ORDERS that the said last-mentioned direction

*BE DISCHARGED

*BE VARIED AS FOLLOWS—

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

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

Judge of the Children Court

*(for said court district)

* Delete words inapplicable