Case 8473

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

Grandparent's dead Uncles & Aunts unknown

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?

By the Guardians of the Poor of the Cannock-Union

17. Has the child ever been convicted? Is so, state the nature of the child's offence and term of imprisonment

no

18. Has it ever attended day school? If so, where and for how long and in what Standard is it?

Yes Brewood N Infant 1896 to 1900. Coven Ch School 1900 to 1901 (Standard I)

19. Ever attended Sunday School? Is so, where and for how long?

Ch of Song S.S. Brewood 1896-1900 Coven Ch S.S. 1900-1901

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

Yes from birth until about March 1896

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

no

22. Is the child subject to fits or has the child ever had one? If so, state its nature. Is this 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

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

Yes has had small pox
yes

25. Is the child's general health good?

yes

[?] Stafford

26. Are the child's 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 by S who is known to me as a responsible person.

Name R

Address Coven Vicarage

Incumbent of Coven

Date 5 Aug. 1901

Overwritten in pencil: filled in largely from my own knowledge