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If a Surgeon shall have refused to grant a Certificate of Age to any Child or young Person the Word "Refused" shall be written by the Surgeon in the Column of the Register where the Numbers of the Certificates are required to be inserted.

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residing in

examined by me this

eight hundred and

VICTORIA, C.

duly appointed a certifying Son [or Daughter]

has been personally

One thousand

Day of and that in my Opinion the said [Child or young Person] has not the ordinary Strength and Appearance of a Child of at least Eight Years of Age [or of a young Person of at least Thirteen Years of Age], or [or and] is incapacitated by Disease and bodily Infirmity from working in a Print Work for the Time allowed by this Act.

Signed

Certifying Surgeon.

N.B.-The Words within Brackets shall be in the Handwriting of the certifying Surgeon, who shall insert the Reason of his Refusal to be either on account of deficient Age or bodily Infirmity, or both, as the Case may be.

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I HEREBY certify, That the Child A.B., Son [or Daughter] of C.D. and E.F. residing in

me at

attended the School kept by

in the Parish and County of

for the Number of Hours and at the Time on each Day specified in the Columns opposite to his [or her] Name.

During the Week ending on Saturday the

of

Wednes

18

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Day

Monday. Tuesday. day.

Thursday. Friday. Saturday.

From To From To From To From To From To From To

Total Number of Hours during this Week.

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From To From To From To From To From To From To

Total Number of Hours during this Week.

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Under the Column headed with the Days of the Week the Periods of the Day that each Child attends School shall be stated, as thus, from Nine to Twelve, or from Two to Five, or any Time, as the Case may be.

other

The Time when each Child attends School, or the Word "Absent," shall be stated in the Column for each Day in the Handwriting of the Schoolmaster; and no Certificate shall be valid unless the Schoolmaster shall, in his own Handwriting, subscribe to it his Christian and Surname in full.

Each Certificate Book shall contain Twenty-six Forms similar to the above, and shall be valid for the Purposes of this Act for Six Months only, either from the First Day of January to the la Day of June, or from the First Day of July to the last Day of December of any Year; and at the Expiration of either Period of Six Months such Certificate Book, containing the School Attendance of the Child certified, shall be delivered by the Parent or other Person having direct Benefit from the Wages of such Child to the Occupier of the Print Work where such Child is employed, and if the Child cease to be employed in the Print Work to the Occupier of which such School Certificate Book was delivered, the Parent or other Person as aforesaid shall be entitled, on demand, to have the said Certificate Book restored to him.

SCHE

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This Register shall contain the Name of every Child employed in the Print Work, to be entered in alphabetical Order, successively when engaged to work, whether for the first Time, or after having left when re-engaged to work.

At the Beginning of this Register shall be inserted

1. The Name of the Occupier or Firm.

2. The Name of the Print Work, the Place, Township, Parish, and County where it is situated, and the Post Office to which the Occupier desires his Letters to be directed.

3. The Nature of the Work carried on.

4. The Clock by which the Employment of the Workers in the Print Work is regulated.

Every Alteration in any of the above Particulars shall be inserted immediately after the Alteration shall have been made.

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The Visits of the certifying Surgeon to the Print Work shall be recorded in this Register in the Manner following.

Date of Visit.

Number of Persons presented for Examination.

Number
of Certificates
granted.

Signature of
Surgeon.

t

*If the Surgeon shall be told that there is no Child or young Person in the Print Work to be examined at the Time of his Visit he shall insert in this Column the Word "None."

† If none be granted he shall insert the Word "None."

SCHEDULE (C.)

Notice to be fixed up in the Print Work.

FORM for the NOTICE to be fixed up of the Names and Addresses of the Inspector and Sub-Inspector, and the Clock for regulating the Hours of Work in the Print Work.

Name and Address of the Inspector of the District

Name and Address of the Sub-In-1 spector of the District

Name and Address of the Surgeon

who grants Certificates of Age for the Print Work

Clock by which the Hours of Work

are regulated

SCHEDULE (D.)

Forms of Summonses and Conviction.

FORM OF SUMMONS to be issued by an Inspector or Sub-Inspector against a Person who has committed an Offence.

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WHEREAS it appeareth to me, I.F., one of Her Majesty's Inspectors [or Sub-Inspector] of Factories, that A.D. of

in the County [or Borough, &c.] of

against the Act made in the

hath offended

Year of Her Majesty's

Reign, intituled [here set forth the Title of this Act], forasmuch

as he the said A.D., on the Year of our Lord

Borough, &c.] of

at

Day of

in the

in the County [or did [here set forth the Substance of the Charge]: These, therefore, are to require you forthwith to sum mon the said A.D. to appear before such Two or more of Her Majesty's Justices of the Peace acting in and for the County [or Borough, &c.] of who shall be present at

LA

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of the same Day, to answer to the said Charge, and to be further dealt with according to Law, and be you then there to certify what you have done in the Premises.

Given under my Hand this

in the Year of our Lord

Signed

Herein fail not.

Day of

I.F., Inspector [or Sub-Inspector].

FORM OF SUMMONS of a Witness to be issued by an Inspector or

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WHEREAS it appeareth to me, I.F., one of Her Majesty's Inspectors [or Sub-Inspector] of Factories, that A.D. of in the County [or Borough, &c.] of

the Act made in the

hath offended against Year of Her Majesty's Reign, intituled [here set forth the Title of the Act]; forasmuch as he the said A.D., on the our Lord

of

at

Day of in the Year of in the County [or Borough, &c.] did [here set forth the Substance of the Charge,] and that B.P. of in the County [or Borough, &c.] is a material Witness to be examined concerning the said Charge: These, therefore, are to require you forthwith to summon the said B.P. to appear before such Two or more of Her Majesty's Justices of the Peace acting in and for the County [or Borough, &c.] of as shall be present at in the County Day of

[or Borough, &c.] of

at the Hour of

on the

in the

noon of the same Day, to testify his Knowledge concerning the Premises, and be you then there to certify what you have done in the Premises. Herein fail

not.

Given under my Hand, this

in the Year of our Lord

County of

[Liberty or Borough,

Signed

Day of

I.F., Inspector [or Sub-Inspector].

FORM of CONVICTION.

Be it remembered, That on the

Day of

as the Case may be.] eight hundred and

in the Year One thousand

A.B. [describe the Offender] is convicted before us J.P. and K. Q., Two of Her Majesty's Justices of the Peace for the County [Liberty or Borough, as the Case may be,] of in pursuance of an Act passed Year of the Reign of Queen Victoria, intituled [here insert the Title of this Act], for that he [describe the Offence].

in the

Given under our Hands and Seals, the Day and Year above

written.

J.P. (L.S.)
K.Q. (L.S.)

8 & 9 VICT.

САР.

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