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Ver been known by any other name? No Yes Write them all out below 1. 2. 20 What date did the child come into your care? Day Month Year 21 What is the child s relationship to you? 22 What date was the child born? Day R30 NOV 2013 Month Year Child Inclusion form Page 3 23 Who are the child s parents? Parent 1: Full name 24 Parent 2: Full name Are there previous caregivers for this child? No Give their names below Yes 1. 2. 25 Do you have a shared custody arrangem.

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