7. 2I | : aor 49 F ry TE ITT § +4 +: + 7 : j “Eric -i r 4 a 7 t4444- ~F+-1- Ad if - > IS}-t4-f- ¥ 2 Be q pt - 7 | | f Ty f ° it af TTT HEE 5 F44444¢444-44 tATT TI i3}-1-F ETP yah An ie + L+T | TRE ! a rt Ty om Ic 4 | ary 4 tea 44 ae PTA -T- Ee attest tt t4+444. 44+ if. | TTITT oo deh 9 AT 1 1 . | 1 . Boy/Girl Mother's name PT PTTET on fasten baz Registration No. Father's name TI oe ' 4 -f 4 TTITih 4a tag an 60 62 4 56 ta co nee e beet - —_— . : eee ee Osta of teonsnseamnissatiane oe eceeees dasseesceecceren couse i UPTO)BeOO | ee | Pade ob cetievannbsteno cece cece cee cee tca sree eneasane { ' STTeTe Negistration No. POLIOMYELOUTES ILIMUNISA TION Diate col bigsd Geuesnwesnesedaoey o.oo... ceee cess eeee ee ececeee Date first seen CDinter Cob serceneved geenener seedsialdennd 2. ses sens eceeeesereeeeees oo. oe Barthday-birthweight Nate of thrced deassvanaiiabioay oo. eee eee LL. . ne ee ee . ’ . ee —_—— ee WHOOPING COUGH, TETANUS & maT Where tie family live: address \ . i i | CAL DIPLITHERIA IMRIUNISA TION Pate of Ciest ivanbsatiateeccececcee ce ceeseee j j Date af secre! lv anisctien ere ceeee ones BROTHERS ANDSISTERS a * - IMATISATION JT TT ct et ey in nee ree ere eee cannes sreceey Po tj-LE eect Chikl’s name _ 44 anh} fete ‘|. . ———- Eee et | At —ee eee Ty yom ent ee Cat: cf OG janngateeeein ation reeees a LETT TTT ~ Child's He. +t-+- : (S}- TT “EP Tn Male Clinic “La Ly eS Ree eRESe +"1 Road to Health Chart bitte pis 1 - tt 4 4 Ce ftp 4 +t -t-Ftrrn@nr i sat} 44 r 4+ 4 TPe | U wr Ld 4 ote ee ee ANTE TOUCKCULOUES IMMUNISATION (BCG) Yeur of birth | Boy/Girl Remaks Drinter col Wearad duevanvnsaetvantiena ee cesstee ee eeeeseeee: ere ! i [MEASLES InmuritinTON MEASLES IMMUEEA : ; . Date of dnemsisadiow oy eens laneaeauesneaces ween ee eee ee | \ | eee eee eee OTHER IMMUNISANONS : peer 3-4 years 4-5 years PERU O ONT OUT ERED EN OT RT APH E Mewes CAEN EDO OTE TOUPEDE S PCRS PRE EEE DEMS at se hgeee ‘ ;