…………………………………………………………………………………… Applicant

of…………………………………………………………………………………

…………………………………………………………………………………… Respondent

of……………………………………………………………………………………

UPON APPLICATION made to the Court today by the Health Service Executive under section 23B of the above mentioned Act for a special care order in respect of the above-named child who appears to the Court to be aged ……… years having been born *(so far as has been ascertained) on the ……… day of ………………………… and who *resides *has been found at …………………………… in said court district.

THE COURT

BEING SATISFIED THAT notice of the application was duly served,

BEING SATISFIED THAT a family welfare conference (within the meaning of the Children Act 2001) has been concluded

HAVING TAKEN INTO ACCOUNT the views of the Special Services Residential Board

BEING SATISFIED THAT the behaviour of the child is such that it poses a real and substantial risk to his or her health, safety, development or welfare and

BEING SATISFIED THAT the child requires special care or protection which he or she is unlikely to receive unless the Court makes such an order.

HEREBY ORDERS that the above-named child …………………………. be and is hereby *placed *maintained in the care of the applicant Executive for the period of ……………….. (being not less than three months or more than six months) from *the date hereof *the date upon which the child is delivered into the custody of the Executive.

And the said Executive is hereby authorised to provide appropriate care, education and treatment for the child and, for that purpose to place and detain the said child in a special care unit provided by or on behalf of the said Executive pursuant to section 23K of the said Act of 1991, namely, ……………………………….at…………………………………………….

And the Court further directs under section 18 (7) of the Act of 1991 as follows:-

………………………………………………………………………………………………..

Dated this ………………… day of ………………………..20…

Signed ……………………………………….

Judge of the Children Court