CHILD STUDY REPORT

 

 

INFORMATION ON THE CHILD TO BE PLACED 

IN GUARDIANSHIP / ADOPTION

 

1.  Name of the Child:

2.  Reference No. as per General Register:

3.  Date of Birth:

4.  How assessed:

5.  Place of Birth:

6.  Sex

7.  Colour of eyes:

8.  Colour of hair:

9.  Complexion:

10. Weight:

11. Height:

 

SOCIAL DATA

1.  Date of arrival of the child:

2. When and how was the child admitted:

a) Admitted directly:

b) Trasnferred from any other institution

and if so, give particulars:

c) Any other source:

3.  Circumstances under which trhe child came to

the original institution:

4.  Information about the natural parents, their health, etc., if any:

5.  Information about the near relatives, if any:

6.  In case if the parents are alive, have they agreed to give away the child in Adoption/Guardianship, if so, whether written consent has been obtained:

7.  Whether the natural parents and/or any relatives have established any contact with the child after his/her admission to the institution:

8.  Is the child destitute:

9.  Any other information:

 

BEHAVIOURAL OBSERVATIONS

1.  How long has the child been with your institution:

2.  Physical, intellectual and emocional developement:

 

 

ASSESSTEMENT

 

 

 

 

 

I (nombre del director del orfanato)______________________________________

hereby certify that the information given in this report about the child is correct.

 

Place:                                                                Signature:

 

Date:                                                                Name:

 

                                                                        Designation:

 

We have read and understood the contents of this Child Study Report and are willing to accept:_____________ (nombre indio del niño/a) as our adoptive child.

 

 

 

 

________________________                        __________________________

(Signature of the male applicant)                        (Signature of the female applicant)

 

 

 

 

 

_________________________                        _________________________

(Name of the male applicant)                         (Name of the female applicant)

 

 

 

Place:

Date:

 

 

Índice de pasos