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,

NOW, THE COURT on the application of the above-named applicant under section 13 (7) (a) of the Act for directions in relation to the said child,

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 DIRECTS under the said section 13 (7) as follows:—

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

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

Judge of the Children Court

*(for said court district)

* Delete words inapplicable