{"text":"STRICTLY CONFIDENTIAL SWS FORM CH2 \nRevised 1\/4\/83 \nADMISSION FORM FOR CHILDREN \nPlsasa sond both parts Please use ink. not pencil, and write \nof this form to SWSG Please refer to notes issuad for 1\/4\/83 carsfully in ths centre of sach box. \n\u2014~\u2014~ \nwatoance mumoer 19 [ 1] 710 3] 4|50 ] \/] w[s[A]ABEIRIS] | | \nSex (1 boy, 2 = girl) 10 |\/ Initials 23.30 | G, \nDate of birth (D.M.Y.) 11-16 | I l \/ ] o | | I 1=new admission 3=transfer \n31412 Type of admission 31 \n2=re-admission 4=\u2014=amendment \nL PERSONAL INFORMATION Col. 1|3 C. PRESENT PERIOD OF CARE OR SUPERVISION \n1 Reference number2-10 I \/ l L l > la l 3 Iq, ISLO [ 1 Date of admission (D.M.Y.) 31-36 2\u20188 0 I3 g 2 \n2 Sex (1=boy. 2=gnl) n \/| 2 Reason for admission-Statute 37.38 | 9 L \n3 Date of birth (D M.Y.) 12.17 11013 2, Primary reason within statute 39-40 & a \n3 Accommedation-Type 4142 .3 Il \n4 Physical handicap or mental disorder 18 District code 43-44 J \u00e9 \npunch\u2014skip 45-54 \n\u00a7 Social Work Department 19-20 \/ 6 4 Number of previous periods of care or supervision 55 @ \n(if none, enter O: if 9 or over, enter 9} \n8 Area Code 2122 | 2o \nSPARE BOXES t- \nfor use, see noles 56-57 \u2019 \n4 \n58-59 t \nk wss [T 1 ] \nB. FAMILY INFORMATION (ar date of admission) Col 1 E \nol \n1 Household composition code 23 4 \nD. MOST RECENT PREVIOUS PERIOD OF CARE OR SUPERVISION \n2 District code of tesidence 2425 | J1g, punch\u2014teproduce columns 2-10 \n3 Employmeant code of father 26 '3. \n4 Employment code of mother 27 | & Date of admission (D.M.Y.) 11-16 \nReason for admission-Statyte \n. . 1 Primary reason within statute \n5 Number of children in household (9 or over, enter 9) 28 '7\u2018- \n. | Date of discharge (D.M.Y.) 21-26 \n& Birth order of child (9 or over. enter 9) 29 _3_ \n. . Reason for discharge \n7 Number of siblings in care or under supervision 30 O \n(9 or over, enter 9) \nPrinted In ths UK for HMSO Dd. 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