Case 326

13. At what address and with whom is the boy now living?

Parade Fulham

14. Give in full the names, addresses, ages, occupations and earnings of each living relative the child to known to possess either on the father's or mother's side such as grandparents, uncles, aunts, &c.

DEGREE OF RELATIONSHIP, NAMES, ADDRESS, AGE, OCCUPATION, WEEKLY EARNINGS

Grandmother, on mothers side both in service & willing to contribute to pay for the child 1/6 each weekly.

Aunt, on mothers side both in service & willing to contribute to pay for the child 1/6 each weekly.

15. State whether any of his relatives are in your judgment in a position to maintain him, or to contribute in any degree to his support.

16. Has he ever been convicted? Is so, state the nature of his offence and term of imprisonment.

No.

17. Has he ever attended day school? If so, where and for how long?

Yes.

18. Has he ever attended Sunday School? Is so, where and for how long?

19. Has he ever been in the workhouse? If so, for how long and where?

Was born there

20. Has he any affections of the limbs, joints, skin or eyes which may have the affect of preventing him from entering domestic services?

21. Is he subject to fits? or has he ever had one? If so, state its nature. Is this child subject to incontinence of urine?

22. Is he at present affected with any infectious or contagious disease, or with scrofula requiring medical treatment?

23. Has he had scarlet fever, or whooping cough or measles, or small pox? If not the latter, has he been vaccinated?

24. Is his general health good?

Yes.

25. Are his parents, grandparents or next of kin, willing to sign an agreement to commit the boy wholly to the care of the Managers of the Home, to obey the rules in force, and to permit the said boy when fully trained to be sent to any situation in the United Kingdom, which may be obtained for him by the Managers?

Yes.

I certify that the foregoing questions have been correctly replied to.

Name - Mrs. H.

Address - Matheson Road West Kens

Incumbent of

Date

District Visitor for S. Clements Mission Fulham