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

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

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

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

WHEREAS IT APPEARS to me from the sworn information of the above-named applicant that the above-named child being in the care of the ..................... Health 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 BEING SATISFIED that there are reasonable grounds for believing that the said child is in the place set out hereunder,

I HEREBY AUTHORISE YOU, ............................... of ........................... a member of the Garda Síochána, accompanied by such other members of the Garda Síochána as may be necessary, to enter (if need be by force) and to search the

† ............................................ at ......................................................... in the said court district

for the said child ..................

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

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

Judge of the Children Court

*(assigned to the said district)

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

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

the above-named member of the Garda Síochána

* Delete words inapplicable
† Name the house or other place as set out in section 46 (6) of the Act.