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

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

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

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

UPON APPLICATION made to this Court to-day by the above-named applicant under section 47 of the above-mentioned Act for an order giving directions on the following question affecting the welfare of the above-named child who is in the care of the ................ Health Board in the said Court district:—

THE COURT 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 47 as follows:—

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

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

Judge of the Children Court

*(assigned to the said district)

*Delete words inapplicable