THE CHILDREN (ADOPTION OF) ACT
THE CHILDREN (ADOPTION OF) ACT
THE CHILDREN (ADOPTION OF) ACT
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<strong>CHILDREN</strong> (<strong>ADOPTION</strong> <strong>OF</strong>) 31<br />
SECOND APPENDIX<br />
PART I. Particulars relating to the child L.N. 272157<br />
Confidential: On completion forward promptly to Secretary, Adoption<br />
Board.<br />
Name. ...................................... Date of Birth.. ...........................<br />
(Surname) (Christian Names)<br />
Address. ...................................<br />
. .<br />
.Nationality.................................<br />
Weight at Birth ........................... What Age did Child Walk? ...........<br />
(State if premature)<br />
Was Mother's Confinement Normal<br />
or Instrumental? .................. What Age did Child Talk? ............<br />
Child was: (A) Entirely Breast Fed ............ Has Child any Right<br />
or Interest in<br />
(B) Partially Breast Fed .......... Property? ..................<br />
(C) Entirely Bottle Fed ..............................................<br />
(Strike out as appropriate)<br />
(If yes, give particulars)<br />
Was Child Baptised? ................... Child's Life Insurance ................<br />
(State type of Policy and Amount)<br />
Place of Baptism ....................... Why is Child offered for Adoption<br />
Denomination.. ..........................................................................<br />
Mother<br />
FAMILY HISTORY<br />
Father<br />
Name ........................................ Name ........................................<br />
(Surname) (Christian Names)<br />
(Surname) (Christian Names)<br />
Address. ................................... .Address.....................................<br />
Age. ..............Religion............... .Age..............Religion................<br />
Marital Status.. .......................... Marital Status ............................<br />
Husband's Full Name .................. Wife's Full Name .......................<br />
..........................................................................................<br />
Sex and Age of Other Children ....... Sex and Age of Other Children .......<br />
..........................................................................................<br />
..........................................................................................<br />
..........................................................................................<br />
..........................................................................................<br />
..........................................................................................<br />
[The indusion of this page is authorized by L.N. 55119841
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