_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ __________________________________________________________________________________________________ State what efforts have been made to trace the parents or relatives and to return the child to his/her family. _________________________________________________________________________________________________ __________________________________________________________________________________________________ Details of medical history, including immunisation _________________________________________________________________________________________________ __________________________________________________________________________________________________ Details of education— School _________________________________________________ Class _____________________________________ Name of supervising officer____________________________________________________________________________ Address ___________________________________________________________________________________________ ___________________________________________________________ Supervisor’s signature ____________________________________________________________ Date _____