Intake Summary Report No Referral Hx for Refenai Id: 1618420 22.. Page 2 of 6 SCHOOL INFORMATION FOR PERSONS REFERRAL Name I School Name 1 Address City. st Zip ELEMENTARY STREET CHILD ABUSEINEGLECT ISSUES AND ALLEGATIONS OR CONCERNS VANCOUVER. WA 98660 2300 VANCOUVER. WA . . 98664 6026 Sr "Negligent Treatment or Maltrea .. .. - incident Address: Same As Primary Address Primary Address: VANCOUVER. WA 98684 Incident Date: incident Time: NIA @351' I fit"-7' ALLEGATIONS: The referent had two conversations with m(age 9) adoptive mother, and she art; tyyin sister as criminals, say scheme. The referent says these in%" ropriate statements in front and beam' alarms on the bedroom doors. The mother also made a comment in front of ail three of her child, that her 3 year old bio-child.-- is a product of rape by her ex-husband. The mother says that --and- spread blood and bodily fluids throughout her house. and explained that they push on their noses until they have bloody noses and they urinate out the windows and on the carpet (see associated referral #1616575). "Ln; gbfigut the iciren's hflger as the mother says the stale 32 crackers from school and that and ate them all up. The referent is concerned they take the food out of hunger rather than being "thieves" as the mother characterised their actions. The 'fiiftiit?r have never adopted them"an want on to say that she tried to return the children to the State. but they won't take them back and the State just keeps giving her money. The mother says they've been in her care for past 8 years and that she foresees their future 'as being locked up. The mother reports at the twinsfiare adogt tandthat they inad her ife,'wrecking her marriage and her house. 13313 I tr 1 uaaysfineonn-: The engaged doesn't exhibit the behaviors his mother is describing and the mother's response to hi was t"he is a con artist 'and can smell" a CPS worker a mile away." . The referent believes that the kids are involved in services at CRMH. -. . -gm-r~ Native Ancestry Questions 1. is this child of American Indian, Alaskan Native or Canadian First Nation ancestry? no 2. is there a Tribe. Band. or Native American organization that -considers this child to be a member? no 3. is this child currently or in the past been a ward of any Tribal Court? no 4. is the residence or domiciie of the child or parenticustodian known to be a predominantly lndian community or within the bounds of a Reservation? no 5. is there anyone else we can contact for further information regarding the child's Native Ancestry? parent I Printed by KAREN FREE 02/07/2006 10:46:55 AM 3 90 Osijii/i