AF00166238 School file Broken Hill Public 5-15099A - Flipbook - Page 3
Ilk
ANNEX to Application for the establishment of a 1./exisitcrta,l School at
We, e undersigned parents ( guardians) of children residing within the undermentioned distances of the
proposed
1 School at
hereby undertake that our children,
-whose names are inserted below, shall attend the said school regularly and punctually.
St. 1959
Name of Parent or Guardian.
("To be written by himself.)
Distance from! Distance from
proposed nearest existing
State School. I
School.
„
Full Name of Child.
Religious
Denomination.
q
ii
//
eeez/z..cf-etz)--Zeti
o(JO-r-f-e-ki at,
0,4
•
/0
./
•
0Z(),/t
ra-7
W-eLc4a:
-gcz_eet)
4
&t 451e)
I
ceei
I/
f/
* If the Parent or Guardian be unable to write, his mark must be witnessed by one of the Local Promoters.
