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Childrens Names Wher. Legitimate or Illegitimate
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
Nurses Residence to be Particularised
Weekly Allowance s d
Bounty
When Paid
When Died at Nurse Wher. Occasioned by the Nurses Negligence, or how.
If Removed, When, Where, With whom & how Placed.
Remarks