Name (if known) or description

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

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

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

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

WHEREAS on the application of the ...................... Health Board, made under section *12 (4) *13 (1) of the above-mentioned Act, this Court on the .... day of ........... 19...., made an emergency care order placing the child *named *described above under the care of that board for a period of ....... days,

TAKE NOTICE that the applicant herein will make application at the sitting of the

District Court to be held at ...................................... on the ...... day of ........... 19..... at ....... a.m./p.m. for the Court's directions under section 13 (7) (a) of the Act with respect to:—

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

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

Applicant

To ..................

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

To ..................

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

the above-named respondents)

* Delete words inapplicable