Case 1109

Application for the Admission of a child

1. Give the child's christian name and surname

C

2. State his exact age, and give the date and place of his birth

8 years old on November 1st 1887. Born at Blackburn, Lancaster

3. Legitimate?

yes

4. If baptized, state place and date of baptism

S. John's Parish Church Blackburn about Dec. 20th 1879

5. Parents living?

Father dead, mother living

6. If, however, either or both are dead, state of what disease they died and give the date of their death

Mother
Father epilepsy, 21st August 1886

7. If living, give their exact places of abode, and state how long they have resided there

Palmer St. Frome Selwood since her husband's death

8. Give the christian names and surnames of his parents (in full) and state their ages.

Mother A 35 years, 12th June 1887

9. What was or is the nature of the father's occupation and the amount of his weekly earnings? Give the name and address of his present or last employer.

10. What was or is the nature of the mother's occupation and the amount of her weekly earnings? Give the name and address of her present or last employer.

cleaning when able, the amount very small indeed and uncertain

11. Have the parents or guardians ever received parish relief? If so, to what extent?

For three months; 1/6 and three loaves a week

12. Give the names, addresses, ages, occupations and earnings (if any) of all his brothers and sisters

NAME, ADDRESS, AGE, OCCUPATION, WEEKLY EARNINGS

W, infant, 5 1/2