|
|
Case 91461. Application to the Waifs and Strays' Society 18 July 1902
View the Case Summary.
- 13. At what address and with whom is the child now living?
- Union Workhouse Burton on Trent
- 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 toward its support?
- no
- 16. Can any payment for the child be guaranteed from any source?
- Board of Guardian's Burton-on-Trent
- 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?
- Church Brougham four years standard III
- 19. Ever attended Sunday School? Is so, where and for how long?
- Yes- Church Bourgham
- 20. Has the child ever been in the workhouse? If so, for how long and where?
- yes - one month
- 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
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
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?
- no
yes
- 25. Is the child's general health good?
- yes
These answers were given by the doctor [?]
- 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
Cross written over questions 21-25: Signature
- I certify that the foregoing questions have been correctly replied to by Mr. [?] who is known to me as a responsible person
- Name M
- Address Burton on Trent
- Incumbent of Holy Trinity
- Date July 18, 1902
|
Original document
Click image to view larger in a new window:
|
