Childrens Names Wher. Legitimate or Illegitimate
When Admitted or Born in the House. If not Admitted, Note it.
Age when Admitted
Mothers Name Settlemt.& Residence.
Fathers Name Settlemt. Residence & Occupation
When Placed out to Nurse
Nurses C: & Sir Name If the Mor. Etc to be so Described
Nurses Residence to be plarised.
Weekly Allowance
Bounty
When Paid.
When Died at Nurse, - Wher Etc by the Nurses Negligence, or how.
If Removed, When, Where, With whom, & how Placed.
Remarks.