District No.

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

........ Applicant

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

......... Respondent(s)

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

WHEREAS ON THE APPLICATION by ............ of ............... made under section 37 (2) of the above-mentioned Act, the Court on the ... day of ..... 19.... made an order regarding access to the above-named child, who is in the care of the ....... Health Board at ..........

in the said court district,

NOW, THE COURT on the application of the applicant herein for an order under section 37 (2) (b) of the Act to *vary *discharge the said order,

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

having heard the evidence tendered, and

being satisfied that the welfare of the child so requires,

HEREBY ORDERS that the said order regarding access to the said child

*BE DISCHARGED

*BE VARIED as follows:—

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

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

Judge of the Children Court

* Delete words inapplicable