Childrens Names Wher. Legitimate or Illegitimate
When Admitted or Born in the House If not Admitted,-Note it
Age when Admitted Y: M: D
Mothers Name Settlemt. & Residence.
Fathers Name Settlemt. Residence & Occupation
When Placed out to Nurse
Nurses Christn: & Sir Name If the Mor. or other Relatn: to be so Described.
Nurses Residence to particularised.
Weekly Allowance s d
Bounty
When Paid
When Died at Nurse. Wher. supposed to be Occasioned by the Nurses Negligence or how
If Removed, When, Where, With whom, & how placed
Remarks