SCHEDULE

FORM 48 APPLICATION FOR A CHILD PROTECTION ORDER BY ANY PERSON (OTHER THAN A LOCAL AUTHORITY)

Rule 3.30

Section 57 of the Children (Scotland) Act 1995

Case No

Date lodged

Application to Sheriff at

for a Child Protection Order under section 57(1) of the Children (Scotland) Act 1995

Part 1. DETAILS OF APPLICANT AND OTHER PERSONS WHO THE APPLICANT BELIEVES SHOULD RECEIVE NOTICE OF THE APPLICATION

APPLICANT

[insert name and address, telephone DX and fax numbers and capacity in which application is made]

CHILD

[insert name, address, gender and date of birth] *

RELEVANT PERSON(S)

[insert name, address and the basis for the person being a relevant person within the meaning of section 93(2)(b) of the Act]

SAFEGUARDER

[insert name, address, telephone DX and fax numbers (if known) of any safeguarder appointed by a children’s hearing or court in respect of the child]

LOCAL AUTHORITY

[insert name and address, DX and telephone and fax numbers]

THE PRINCIPAL REPORTER

[insert name, address, telephone DX and fax numbers]

ANY OTHER PERSON WHO SHOULD RECEIVE NOTICE OF THE APPLICATION

[For example, any person who is caring for the child at the time of the application being made: insert name, address of person and provide details of their interest in the application and/or child]

* Note: Information to be provided in Part 3 where applicant does not wish to disclose the address or whereabouts of the child or any other person to persons receiving notice of the application.

Part 2. INFORMATION ABOUT THE APPLICATION AND ORDERS SOUGHT

GROUNDS FOR MAKING APPLICATION

[applicant to provide details of grounds for making the application: see section 57(1) of the Act]

OTHER APPLICATIONS AND ORDERS WHICH AFFECT THE CHILD

[insert details of any other applications or orders made which affect or are relevant to the child who is the subject of this application]

SUPPORTING EVIDENCE

The following supporting evidence is produced –

[list reports, statements, affidavits or other evidence produced]

Part 3. Details of Order sought and any terms, conditions or directions

ORDER SOUGHT: The applicant requests the Sheriff to make a Child Protection Order in respect of the child[insert name]

*TERMS AND CONDITIONS TO BE ATTACHED TO ORDER

In terms of section 57(4) the applicant seeks an order to

[insert details of the order sought].

*DIRECTIONS IN RELATION TO THE EXERCISE OR FULFILMENT OF PARENTAL RESPONSIBILITIES OR PARENTAL RIGHTS

In terms of section 58(4) or (5) the applicant seeks the following direction(s) –

[insert details of the direction(s) sought].

*ANY OTHER ORDER(S)

[Insert here details and grounds for any order sought in relation

a

to non-disclosure of address or whereabouts of child; or

b

service of restricted documents on child.]

*delete as appropriate

PART 4. DETAILS OF FIRST ORDER SOUGHT FROM THE SHERIFF

The applicant requests the sheriff to:

a

Make a child protection order in respect of the said child[insert name of the child] on the terms and conditions set out in Part 3 of the application, * and subject to the directions sought in Part 3 of the application.

*b

Order the applicant to forthwith serve a copy of the Child Protection Order [and a copy of the application] on,

i

the child, together with a notice in form 50* or orders service of the following documents only[insert details of documents to be served on child, e.g. notice in form 50 only ]; and

*delete as appropriate

ii

the persons listed in Part 1. of this application, together with a notice in form 51.

*c

Order that the address of[insert name] should not be disclosed in the application.

*d

Dispense with service on the child or any other person for the following reasons[insert details].

SIGNED.................... DATE....................

[name, designation and address telephone, DX and fax numbers]