Pancho - PAD-JAS-05

Code: PAD-JAS-05
Mercy ID: V-03513-12
Encounter Date: 02/02/2011
Last: Padilla
First: Jasmine
DOB: 01/06/2005
County: Gwinnett
Street: 3343 J Peachtree Corners Cr.
City: Norcross
State: GA

Zip

30092-

Cell

(678) 260-4395

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Guadalupe Garcia	09/05/1980	Mexico
Father	Othoniel Padilla	07/12/1969	Mexico
Step Parent	N/A	N/A	N/A

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

Intake: Volunteer
Data Entry: J. Manzo