District No.

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

.......... Applicant

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

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

of .........

WHEREAS UPON APPLICATION by the above-named health board, made under section 37 (3) of the above-named Act, with respect to the above-named child who is in the care of the board at ........... in the said court district, THE COURT on the ... day of .... 19.... MADE AN ORDER authorising the board to refuse to allow ....... of ....... access to the child,

NOW, THE COURT on the application of the applicant herein under section 37 (3) of the Act for an Order to *vary *discharge the said order,

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 order authorising the health board to refuse to allow ......... 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