District No.

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

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

of .........

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

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

WHEREAS ON APPLICATION by the above-named health board, made under section ..... of the above-mentioned Act THE COURT on the ... day of ........ 19... MADE A SUPERVISION ORDER authorising the board to have the above-named child, who resides at ........... in the area of the board and in the said court district, visited 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 in loco parentis) any necessary advice as to the care of the child,

*(AND WHEREAS the said order contained a *condition *direction that—

NOW, THE COURT on the application of the applicant herein under section 22 of the Act to *vary *discharge the said *supervision order *condition *direction,

being satisfied that notice of the application herein was duty served,

having heard the evidence tendered, and

being satisfied that the welfare of the child so requires,

HEREBY ORDERS that the said *supervision order *condition *direction

*BE DISCHARGED

*BE VARIED as follows:—

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

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

Judge of the Children Court

* Delete words inapplicable