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

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

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                                                                        (name of the treatment centre)

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                                                              (physical address [sic] the treatment centre)

Name of the child __________________________________________________________________

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Identity No. of the child

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Residential address of the child

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Signature of person acting on behalf of the child

PLACE: ________________________________________________

DATE: _________________________________________________