Personal and Family Information:
HEALTH OF THE CHILD
( x ) Good ( ) Poor ( ) Disabled ( ) Other
PARENTS LIVING
( x ) Both ( ) Mother ( ) Father ( ) Neither ( ) Unknown
SCHOOL
( x ) Pre-School ( ) School Grade ( ) Other
CHRISTIAN STATUS (Child's Family)
( ) Strong ( ) Average ( ) Weak ( x ) Non-Christian
FAMILY BACKGROUND
FATHER: AGRICULTURAL LABORER MOTHER: DAILY WAGE LABORER
BROTHERS: 0 SISTERS: 1
INTERESTS OF CHILD: (Favorite Sports, hobbies or talents)
( x ) Play ball ( x ) Play games ( ) Art ( x ) Drawing ( ) Singing ( ) Music
DESCRIPTION OF LIVING QUARTERS:
( ) House ( ) Rented Room ( x ) Tin Shack ( ) Thatched House |