Form P&C1

REPUBLIC OF KENYA

IN THE CHILDREN’S COURT AT ……………………………………………………………………………………………….........

PROTECTION AND CARE NO. ………………….………………………………………………………………………………......

APPLICATION FOR AN ORDER UNDER SECTION …………………………………………………….. OF THE CHILDREN ACT

C.O/S.NO…………………………………………………………......
Police Case No. ………………………………………………….........…….
Date to Court………………………………………………………....….
Protection and Care No. ………………………………………………………….....

Child’s Particulars
Name of Child…………………………………………………………………………………………………………………..….
Apparent Age……………………………………. Gender…………………………………………… Nationality……….…….
County…………………………………Language(s) ………………………. Religion…………………. Disability…………….
Special needs (list any needs that the child may have)
……………………………………………………………………………………………………………………………………..

Parent(s)/Guardian(s) Particulars
Name 1. ………………………………………………………………………………………………………………………….
2. ………………………………………………………………………………………………………………………….
Telephone/mobile ………………………………………………………………………………………………………………..
Physical / Home Address………………………………………………………………………………………………………….
Postal Address…………………………..………………………………………………………………………………………….
Relationship with the child ……………………………………………………………………………………………………......

CATEGORIES OF CHILDREN IN NEED OF CARE AND PROTECTION

(tick as appropriate) A child who/whose,
• has no parent/guardian
• has been abandoned by his parent or guardian,
• is destitute
• found begging or receiving alms
• parent has been imprisoned
• parents or guardian find difficulty in parenting
• parent or guardian does not or is unable or unfit to exercise proper care and guardianship
• is truant or is falling into bad association
• is prevented from receiving education
• is subjected or is likely to be subjected to female circumcision or child marriage or to
customs and practices prejudicial to the child’s life, education and health
• is kept in any premises which, in the opinion of a medical officer, is overcrowded, unsanitary
or dangerous
• is exposed to domestic violence
• is pregnant
• is terminally ill,
• parent(s) is terminally ill
• has a disability and is unlawfully confined and or is ill treated
• has been sexually abused or is likely to be exposed to sexual abuse and exploitation
including prostitution and pornography
• Is engaged in any work likely to harm his/her health, education, mental or moral
development
• Is displaced as a consequence of war, civil disturbances or natural disasters
• Is exposed to any circumstances likely to interfere with his/her physical, mental and social
development;
• Is engaged in the use of, or trafficking of drugs
• Any of the offences mentioned in the Third Schedule to the Children Act; (includes assault,
unnatural offences and offences within the sexual offences Act)
o committed against him
o or if he is a member of the same household as a child against whom any such offence
has been committed or
o is a member of the same household as a person who has been convicted of such an
offence against a child

BRIEF FACTS

As being in need of Protection and care under section ……………………………of the Children Act No. 8 of 2001

Applicant…………………………………………………………………………………………………………………