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Case 36232. Application to Waifs and Strays' Society (W) c. May 1893
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- 13. At what address and with whom is the child now living?
- 14. Give in full the names, addresses, ages, occupations and earnings of each living relative the child is 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
- 15. State whether any of the child's relatives are in your judgment in a position to maintain the child, or to contribute in any degree to its support.
- 16.Can any payment for the child be guaranteed from any source? If so, by whom?
- 17. Has the child ever been convicted? Is so, state the nature of the child's offence and term of imprisonment.
- 18. Has it ever attended day school? If so, where and for how long and in what Standard is it?
- 197 The Grove. Camberwell. 3 years
- 19. Ever attended Sunday School? Is so, where and for how long?
- No.
- 20. Has the child ever been in the workhouse? If so, for how long and where?
- 21. Has the child any affections of the limbs, joints, skin or eyes which may have the affect of preventing her from entering domestic services?
- No. No.
- 22. Is the child subject to fits or has she ever had one? If so, state its nature. Is the child subject to incontinence of urine?
- No.
- 23. Is the child at present affected with any infectious or contagious disease, or with scrofula requiring medical treatment?
- No complaint of any kind. Yes vaccinated in India.
- 24. Has the child had scarlet fever, or whooping cough or measles, or small pox? If not the latter, has it been vaccinated?
- Had measles only.
- 25. Is the child's general health good, and has it average mental capacity?
- Yes. signature
- 26. Are the child's parents, grandparents or next of kin, willing to sign an agreement to commit it wholly to the care of the Managers of the Home, to obey the rules in force, and to permit the said child when fully trained to be sent to any situation in the United Kingdom which may be obtained for it by the Committee?
- I certify that the foregoing questions have been replied to by who is known to me as a responsible person.
- Name
- Address
- Incumbent of
- Date
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