JUVENILE COUKT BLANK, No. 3.-P, F. Pettibone & Co., Law and rabtie omee Stationers, Chleago-
HISTORY SHEET
Name of child
Date of birth, as near
known,
Name and address of present custodian-
Father's name and address
Where born
Creed
Mother's name and address.
Where born
Creed
Name and address of legal guardian, if any.
Father's occupation and income.
Mother's occupation and income.
Attends what school.
Teacher's name
State of health
Physician.
If the child has ever been arrested, give particulars and dates
Give previous history and particulars relating to home life of child, with causes of
Dependency and Delinquency
