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Case 96352. Copy of the application form
View the Case Summary.
- 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.
- None of his relatives are in a position to help, except an uncle and he is only an uncle by marriage & does not feel himself in any way bound
- 16.Can any payment for the child be guaranteed from any source? If so, by whom?
- No
- 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?
- [?] St. Board School since 1898. Standard II
- 19. Ever attended Sunday School? Is so, where and for how long?
- S. Luke's Sunday Sch. Walsall. since 1898
- 20. Has the child ever been in the workhouse? If so, for how long and where?
- No
- 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
- 22. Is the child subject to fits or has it ever had one? If so, state its nature. Is the 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 it been vaccinated?
- Whooping cough & measles. He is vaccinated
- 25. Is the child's general health good, and has it average mental capacity?
- Yes (parenthetical note to questions 21 through 25: I certify that I have examined T. and that these answers are correct. R. Md. Walsall April 21st 1903)
- 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 am afraid they are not, as the mother want him home to help her as soon as he can work
- I certify that the foregoing questions have been correctly replied to, to the best of my belief.
- Name - J.
- Address - Glenbank Walsall
- Incumbent of - Shake Mission Church
- Date - April 22 1903
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