Pancho - MEN-KEV-01

Code: MEN-KEV-01
Mercy ID: V-02323-21
Encounter Date: 09/27/2006
Last: Mendoza
First: Kevin
DOB: 07/22/2001
County: Cobb
Street: 6109 Black Hawk Trail
City: Mableton
State: GA

Zip

30126-

Home

(678) 698-2419

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Laura Calderon	09/19/1972	Mexico
Father	Mario Mendoza	10/22/1966	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Harmony Leland Elem
Grade: Kinder
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: Volunteer
Data Entry: J. Manzo