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Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008)

Regulations

Regulations for Prevention of and Treatment for Substance Abuse, 2013

Annexures

Annexure F : Forms

Form 7C : Application for admission to a treatment centre on behalf of a child: Section 32(1)(c) of the Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008)

 

 

FORM 7C

 

APPLICATION FOR ADMISSION TO A TREATMENT CENTRE ON BEHALF OF A CHILD:

SECTION 32(1)(c) OF THE PREVENTION OF AND TREATMENT FOR SUBSTANCE ABUSE ACT, 2008 (ACT NO. 70 OF 2008)

 

(Regulation 48)

 

I, ________________________________________________________________________________

Identity number : __________________________________________________________________

residing at

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

hereby apply for admission of the child whose details appear below to the treatment centre:

__________________________________________________________________________________

__________________________________________________________________________________

                                                                        (name of the treatment centre)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

                                                              (physical address [sic] the treatment centre)

 

 

Name of the child __________________________________________________________________

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

Identity No. of the child

__________________________________________________________________________________

 

Residential address of the child

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

 

Signature of person acting on behalf of the child

 

PLACE: ________________________________________________

 

DATE: _________________________________________________

 

 


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