Case 1265

Application for the Admission of a child

1. Give the child's christian name and surname

F

2. State the exact age, and give the date and place of her birth

10 years

3. Legitimate?

illegitimate

4. If baptized, state place and date of baptism

Yes Quebec Chapel while in the Marylebone Home

5. Parents living?

6. If, however, either or both are dead, state of what disease they died and give the date of their death

7. If living, give their exact places of abode, and state how long they have resided there

8. Give the christian names and surnames of her parents (in full) and state their ages.

9. What was or is the nature of the father's occupation and the amount of his weekly earnings? Give the name and address of his present or last employer.

10. What was or is the nature of the mother's occupation and the amount of her weekly earnings? Give the name and address of her present or last employer.

11. Have the parents or guardians ever received parish relief? If so, to what extent?

12. Give the names, addresses, ages, occupations and earnings (if any) of all her brothers and sisters

NAME, ADDRESS, AGE, OCCUPATION, WEEKLY EARNINGS