{"text":"SWS FORM CH2 \nRevised 1\/4\/83 \nADMISSION FORM FOR CHILDREN . \nPlease usa ink, not pencil. and write \ncarefully in the cantre of sach box. ! \nSTRICTLY CONFIDENTIAL \nPleass sand both parts \nof this form to SWSG Please refer to notes issued for 1\/4\/83 \nSurname - i \nReference number 1.9 f (9 ?\u2018 0 3 (1\u2019\u201c[5 [O f 17-28 IS I\u2019q I\"( ]D [\u00a3 IQ [5 l I l f \nSex (1=boy, 2~ gitl) 10 \/ Initials 29-30 c \nDate of birth (D.M.Y.) 11-16 | ! | \/ | O | 3 | I 1=new admission 3=transter . \n712 Type of admission (2:re\u2014admlssion 4=amendment )'31 \n{ _'_}': A. PERSONAL INFORMATION Col 1|3 C. PRESENT PERIOD OF CARE OR SUPERVISION \n1 Reference numbes210 [\/ [ \u00a2 5 [0 ] 3 |t | Slol1 ] 1 psteot admission (DMY) 3136 | 29 ]B 322 \n2 Sex (1=boy, 2=girl) n \/| 2 Reason jor admission-Statute 3738 | o L \n3 Date of bith (DM Y) 1237 [71 ] l 0| 3 l '\u2014'fl 2, Primary reason within statute 3940 6 \n3 Accommodation-Type 4142 | 2 \/ \n& Physical handicap or mental disorder 18 District code 43-44 \/& \npunch\u2014skip 45-54 \n5 Social Wark Department 19-20 \/ 6 4 Number of previous periods of care or supervision &5 @ \n(if none, enter O; if 9 or over, enter 9) \n8 Area Code 2122 | 210 \nSPARE BOXES \ntor use, see notes 56-57 \n: - 58-59 \nT soss| | [ [ | \nB. FAMILY INFORMATION (af date of admission) Col. 1 E \ne \u00a9ol. ' \n1 Household composition code 23 l}_ \nD. MOST RECENT PREVIOUS PERIOD OF CARE OR SUPERVISION \n2 District code of residence 24-25 I I punch\u2014reproduce columns 2-10 \n3 Employment code of father 26 1 \n4 Employment cade of mother 7 |g Date of admission (D.M.Y.) 11-16 \nReason for admission-Statute \n. Fn Primary reason within statute \n5 Number of children in household (9 or over, enter 9) 28 \u20181\u2018- \n. Date of discharge (D.M.Y.) 21.26 \n6 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, enler 9) \nL. Priated in the UK for HMSO Dd. 8815259 4\/84 L103 - - - - - - - - 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