Act of Sederunt (Child Care and Maintenance Rules) 1997

Rule 3.35

FORM 54 S APPLICATION FOR EXCLUSION ORDER BY LOCAL AUTHORITY

Section 76 of the Children (Scotland) Act 1995

Case No

Date lodged

Application to Sheriff at

for an Exclusion Order under section 76(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]
CHILD	[insert name, address, gender and date of birth]*
THE NAMED PERSON	[insert name and address of person to be excluded]
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]
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]
THE APPROPRIATE PERSON	[insert name and address of person who is to have care of the child if the order is made]
THE PRINCIPAL REPORTER	[insert name and address, telephone DX and fax numbers]
ANY OTHER PERSON WHO SHOULD RECEIVE NOTICE OF THE APPLICATION	[insert name, address and telephone numbers 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

CONDITIONS FOR MAKING APPLICATION

[applicant to provide details of grounds for making the application including the address of the family home and details of all persons resident there.]

ANY OTHER RELEVANT APPLICATION OR ORDER WHICH AFFECTS 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]

PROPOSALS BY THE LOCAL AUTHORITY FOR FINANCIAL OR OTHER SUPPORT FOR THE NAMED PERSON

[Insert details; Section 76(9) + (10) of the Act refer]

PART 3. DETAILS OF ORDER SOUGHT AND ANY TERMS, CONDITIONS OR DIRECTIONS

ORDER SOUGHT: The applicant requests the Sheriff to[insert details of the order sought and any terms and conditions to be attached to the order] in respect of the child[insert name]

ANCILLARY OR INTERIM ORDERS SOUGHT

In terms of section 77(3) the following orders or interim orders are sought:

[specify orders sought and provide information about the reasons for seeking order]

TERMS AND CONDITIONS TO BE ATTACHED TO ORDER

In terms of section 77(7) the applicant seeks an order to:

[insert details of the order sought].

DIRECTIONS AS TO PRESERVATION OF NAMED PERSON’S PROPERTY

In terms of section 77(5) the applicant seeks the following direction:

[insert details of the direction sought].

In terms of section 78(1) a power of arrest is sought in relation to:

[insert details of interdict and provide information about the reasons for seeking power of arrest]

PART 4. DETAILS OF FIRST ORDER SOUGHT FROM THE SHERIFF

The applicant requests the sheriff to:

a. Fix a hearing.

b. Order the applicant to forthwith serve a copy of the application on,

i. the child, together with a notice in form 28;

ii. The named person, together with a notice in Form 36 and

iii. The persons listed in paragraph 1 of this application, together with a notice in form 36.

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

*d. Make an interim exclusion order excluding the named person from the child’s family home in terms of part 2* on the terms and conditions set out in part 3 above, and subject to the directions sought.

*e. Grant the following ancillary order.[specify order sought]

*f. Grant a power of arrest.

*delete as appropriate

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

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