Case 9616

Application for the Admission of a child

1. Give the child's christian name and surname

J

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

7 years old. Born Aug. 2 1896 at Chorley, Lancashire

3. Legitimate?

yes

4. If baptized, state place and date of baptism

yes at Chorley Old Parish Ch: at a month old

5. Parents living?

mother only

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

Father killed in an accident Oct. 15/02

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

Mother [came to live] at Main Road, [?] Nottingham during last 4 months

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

Mother S, 33 years

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.

Father was a labourer in Wickyard on Peterborough belonging to gardener & Briston

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.

Mother is practically blind and cannot see at all

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

no

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

NAME, ADDRESS, AGE, OCCUPATION, WEEKLY EARNINGS

--, Far Cotton, 6
--, Far Cotton, 2

13. At what address and with whom is the child now living?