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

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

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

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

WHEREAS IT APPEARS from an application made by sworn information *by *on behalf of the .................. Health Board laid before this Court on the ...... day of ........... 19...., seeking an order under section 46 (3) of the above-mentioned Act with respect to the above-named child, being in the care of the board, was on the ..... day of ........... 19....., without lawful authority.

*(removed from the custody of the board.)

*(removed from the custody of ................................. of .................................. who was taking care of the child on behalf of the board.)

*[prevented from returning to the custody *(of the board) *(of ......................... of ..................................who was taking care of the child on behalf of the board) at the end of a period of leave.)

and that the above-named respondent, *residing *for the time being at ............................ in said court district, can produce the said child,

NOW, THE COURT *(being satisfied that the summons herein was duly served,) having heard the evidence tendered and

being satisfied that there are reasonable grounds for believing that the respondent can produce the child and that the welfare of the child so requires,

HEREBY DIRECTS the respondent .......................................

under section 46 (3) of the Act, to deliver up the said child ..........................

to the custody of the .............. Health Board.

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

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

Judge of the Children Court

*(assigned to the said district)

* Delete words inapplicable