JOY OF GOD ORPHANAGE CHILD DATA COLLECTION FORM

Section A: Personal Information

Full Name: Agnes Kulwa Maico

Date of Birth: 15/12/2023

Age: 1.8

Gender: Female

Place of Birth: Masambi Bukombe Geita

Short Background/Story

She needs care and protection because she comes from a troubled family. Her father is an excessive alcohol drinker, and after her mother left, she was brought to Joy of God Orphanage by a social welfare officer.

Section C: Education Information

Current School:

Class/Grade:

School Performance (Last Exam Grade/Remarks):

Section D: Health Information

Known Medical Conditions:

Allergies: NIL

Disability (if any): NIL

Vaccination Status: I don’t know

Section E: Sponsorship Information

Type of Sponsorship:

   • Education: 0%

   • Health: 0%

   • Food/Nutrition: 0%

   • Clothing: 0%

Other: He Don’t have