District No.

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

....... Applicant

of ........

........ Respondent

of ........

WHEREAS application has been made to this Court by the ........ Health Board under section 18 (1) of the above-mentioned Act for a care order with respect to the above-named child who resides at ....... in the area of the board and in the said court district,

AND WHEREAS the said application has not yet been determined by the Court.

TAKE NOTICE that the applicant herein will apply at the sitting of the District Court to be held at ........ on the ... day of ..... 19.... at .... a.m./p.m. for a supervision order under section 18 (6) of the Act in respect of the said child pending such determination.

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

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

Solicitor for Applicant

To .........

of .......

the above-named respondent.