Childrens Names Wher. Legitimate or not
When Admitted or Born in the House
Age when Admitted Y M D
Mothers Name Settlemt. & Residence.
Fathers Name Settlemt. Residence & Occupation
When Placed out to Nurse
Nurses C: & Sir Name If the Mor. or or. Relation to be so Described
Nurses Residence to be Pelarised.
Weekly Allowance
Bounty
When Paid
When Died at Nurse; Whether Occasioned by the Nurses Negligence or how
If Removed, When, where, with whom, & how Placed.
Remarks