Form 1	Application for prohibition order
Crimes (Child Sex Offenders) Act 2005
(see s 132B (Application for prohibition order))
In the Magistrates Court of the Australian Capital Territory
AP ........../......................(Court to complete)

Applicant		(applicant’s full name), chief police officer

Respondent		(respondent’s full name)

*To: (respondent’s full name) of (respondent’s address)
*And to: (name and address of anyone else the Court directs to be served)

Take notice that the Court will hear an application by (applicant’s full name) on (date) at (time) (or as soon after that as this application can be heard) to make the following orders:
1	(set out briefly orders sought and each party affected by the orders); 
2	any other orders that the Court considers appropriate.

Grounds for application
3	I, (applicant’s full name), the chief police officer, apply for a prohibition order for the respondent because I believe on reasonable grounds that—
(a)	the respondent is a registrable offender under the Crimes (Child Sex Offenders) Act 2005; and
	(state details of each registrable offence for which the person has been found guilty or other details that indicate that the person is a registrable offender)
(b)	the respondent has engaged in conduct the nature or pattern of which poses a risk to the lives or sexual safety of *[1 or more children/children generally]; and
	(state particulars of the conduct and when the conduct happened)
	(c)	prohibiting the following conduct will reduce the risk:
	(state conduct proposed to be prohibited, including any conditions)
Note 1	The conduct that the Court may prohibit includes 1 or more of the following (see Crimes (Child Sex Offenders) Act 2005, s 132F):
•	associating with, or otherwise contacting stated people or a stated kind of person;
•	being in stated places or a stated kind of place;
•	living at 1 or more stated premises or a stated kind of premises or premises at a stated place;
•	engaging in stated behaviour;
•	being in stated employment or a stated kind of employment, whether paid or voluntary, that is likely to bring the person into contact with children.
Note 2	Attending a rehabilitation program for registrable offenders may involve association or contact with other registrable offenders.  A condition allowing contact with registrable offenders in the context of attending a rehabilitation program is recommended if the order prohibits association or contact with registrable offenders.
Note 3	The Crimes (Child Sex Offenders) Act 2005, s 132E sets out the matters that the Court must consider before making a prohibition order for a person.
Additional details of application
4	Is an interim prohibition order sought in this matter?
□	yes
□	no
5	Is the respondent under 18 years old? 
□	yes	(the application must include a copy of the CYP director‑general’s report for the respondent under the Crimes (Child Sex Offenders) Act) 2005, s 132C)
□	no
6	What is the term of the prohibition order sought?
□	the person’s reporting period—(state term)
□	1 year (maximum term if the person is a young person)
□	5 years (maximum term if the person is not a young person)
□	other—(state term) 
Note	See the Crimes (Child Sex Offenders) Act 2005, s 132G.

Date:

*[signature of applicant/representative]

*omit if, or whichever is, inapplicable