This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.
This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.
This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.
This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.
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Republic of the Philippines
Province of Cebu City of Talisay Barangay Lawa-an II Tel. no. 272-4700
OFFICE OF THE BARANGAY CAPTAIN
INITIAL INTAKE FORM
Case No. I. Personal Data Name : __________________________________ Nickname : ___________ Birthdate : __________________________________ Age : ___ Birth Place: __________________ Contact # : ___________ Home Address : ___________________________________________________________ Educational Attainment : ______________________________ Referring Party : _____________________ Contact # : ___________
II. Family Background
Name Relationship to Age Educational Source of Client Attainment Income
III. Reason for Referral:
_____ Trafficking in Persons, for the purpose of: _____Sexual Exploitation ______Forced Labor or Slaverly _____Sale of Organs ______Armed Activities _____Other types of exploitation,specify____ _____Child Sexual Exploitation: _____Child Trafficking ______Child Prostitution _____Child Pornography ______Child Labor _____Child Abuse: _____Physical Abuse ______Sexual Abuse _____Verbal Abuse ______Psychological Abuse _____Other types of abuse, specify_____