Order
| Published date | 21 March 2018 |
| Subject Matter | Family law forms |
C110A - Application for a care or supervision order and other orders under Part 4 of the Children Act 1989 or
an Emergency Protection Order under section 44 of the Children Act 1989 (10.16) © C rown copyrigh t 2016
C110A To be completed by the court
The family court sitting at
Case number Date issued
Child(ren)’s name(s)
Fee charged
Application for a care or supervision
order and other orders under Part
4 of the Children Act 1989 or an
Emergency Protection Order under
section 44 of the Children Act 1989
Name of applicant
Full name of respondent(s)
Nature of application
Care and supervision or other Part 4
Care
Supervision
Interim care order
Interim supervision order
Other (please specify)
Is the Local Authority considering adoption?
Yes No
If Yes, please complete Section 7b
Emergency Protection Order
information on the whereabouts of the child[ren]
(Section 48(1) Children Act 1989).
authorisation for entry of premises
(Section 48(3) Children Act 1989).
authorisation to search for another child on the
premises (Section 48(4) Children Act 1989).
Other (please specify)
Is an urgent hearing required? Yes No If Yes, complete Section 1
Is a without notice hearing required? Yes No If Yes, complete Section 2
Are there previous or ongoing proceedings for the child(ren)? Yes No If Yes, complete Section 3
Are there factors aecting litigation capacity? Yes No If Yes, complete Section 4
Is this a case with an international element? Yes No If Yes, complete Section 5
Will the child or any of the people involved need to use spoken
or written Welsh during the course of the proceedings? Yes No If Yes, complete Section 9
Additional information required
What order(s) are you applying for? (tick all which apply)
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2
Child 1 - Full name of child Date of birth Order(s) applied for
(including interim orders)
D D /M M /YYYY
Is the child accommodated? Yes No
If Yes, from what date? D D /M M /YYYY
Name of mother Name of father Parental Responsibility
Yes No
Summary of
children’s details
Child 2 - Full name of child Date of birth Order(s) applied for
(including interim orders)
D D /M M /YYYY
Is the child accommodated? Yes No
If Yes, from what date? D D /M M /YYYY
Name of mother Name of father Parental Responsibility
Yes No
Child 3 - Full name of child Date of birth Order(s) applied for
(including interim orders)
D D /M M /YYYY
Is the child accommodated? Yes No
If Yes, from what date? D D /M M /YYYY
Name of mother Name of father Parental Responsibility
Yes No
Child 4 - Full name of child Date of birth Order(s) applied for
(including interim orders)
D D /M M /YYYY
Is the child accommodated? Yes No
If Yes, from what date? D D /M M /YYYY
Name of mother Name of father Parental Responsibility
Yes No
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