Aloha House Manual updated 2014

Table of Contents
A.
Historical
Background
..........................................................................................................................................
7
B.
Rationale
................................................................................................................................................................
10
II.
Mission
and
Vision,
Goals
and
Objectives
........................................................................................
12
A.
Goals
.........................................................................................................................................................................
12
B.
Objectives
...............................................................................................................................................................
12
C.
Philosophy
.............................................................................................................................................................
18
III.
Clientele
.....................................................................................................................................................
20
IV.
Geographical
Area
of
Coverage
..........................................................................................................
24
V.
General
Policies
........................................................................................................................................
25
A.)
Service
Policies
...................................................................................................................................................
25
B.)
Admission
and
Intake
Policies
......................................................................................................................
27
C.)
Child
Care
..............................................................................................................................................................
28
D.)
Community
Outreach
.......................................................................................................................................
30
E.)
Administrative
Policies
....................................................................................................................................
31
F.
Home
facility
policies-Environment
..............................................................................................................
34
G.
Child
Protective
Policies
...................................................................................................................................
36
H.
Child
Discipline
Policies
....................................................................................................................................
37
I.
Health
and
Feeding
of
Children
........................................................................................................................
39
1.
Rationale
...................................................................................................................................................................................
39
2.
Experience
................................................................................................................................................................................
40
3.
Visa
Medical
Travel
for
international
adoption
.......................................................................................................
40
4.
Adoptive
Parents
...................................................................................................................................................................
40
VI.
Programs
and
Services
.........................................................................................................................
41
A.
Non
Formal
Educational
Programs
...............................................................................................................
41

B.
Development
Assessment
for
ages
0-6
........................................................
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not
defined.
C.
Types
of
Play
equipment
and
materials
......................................................
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not
defined.
3.
To
develop
expression
and
skill:
.......................................................................
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not
defined.
4.
To
stimulate
imitative
play
and
develop
imagination:
............................
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not
defined.
5.
Suggestions
for
Emotional
Development
.......................................................
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not
defined.
D.
Adoption
................................................................................................................
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not
defined.
1.
Local
Adoption
........................................................................................................................................................................
41
2.
Steps
to
adopting
a
child
from
the
Philippines:
.......................................................................................................
42
3.
Bonding
......................................................................................................................................................................................
44
E.
Community
Outreach
Programs
....................................................................................................................
44
1.
Feeding
centers
......................................................................................................................................................................
44
2.
Medical
Missions
...................................................................................................................................................................
44
3.
Community
Training
............................................................................................................................................................
45
4.
BARANGAY
HOPE
..................................................................................................................................................................
45
5.
School
Program
......................................................................................................................................................................
47
A.
Rationale
&
Objective
..........................................................................................................................................................................
47
B.
The
School
Curriculum
.......................................................................................................................................................................
47
C.
Other
Activities
of
the
Homeschool
...............................................................................................................................................
48
6.
Mothers
with
Hope
..............................................................................................................................................................
49
A.
Rationale
&
Objective
..........................................................................................................................................................................
49
B.
Goals
and
Objectives
............................................................................................................................................................................
49
C.
ASSESSMENT
/
EVALUATION
.........................................................................................................................................................
50
7.
Training
on
Sustainable
Natural
Farming
Methods
..............................................................................................
51
A.
History
&
Background
........................................................................................................................................................................
51

B.
AREA
COVERAGE
AND
BENEFICIARIES
......................................................................................................................................
53
C.
Location
of
Proposed
Project
...........................................................................................................................................................
53
D.
The
Beneficiaries
...................................................................................................................................................................................
53
E.
The
Long
Term
Goal
and
Direction
of
the
Project
...............................................................................................................
54
F.
Goals
and
Objectives
............................................................................................................................................................................
54
G.
Implementation:
....................................................................................................................................................................................
55
VII.
Organizational
Structure
....................................................................................................................
58
A.
Governing
Board
..................................................................................................................................................
58
1.
Board
of
Directors
.................................................................................................................................................................
58
2.
Duties
of
the
Board
...............................................................................................................................................................
58
3.
Structure
....................................................................................................................................................................................
59
A.
Aloha
House
Board
of
Directors
....................................................................................................................................................
59
B.
Organizational
Structure
...................................................................................................................................................................
59
C.
Communications
Flow
Chart
............................................................................................................................................................
60
VIII.
Personnel
and
Staff
.............................................................................................................................
61
A.
Positions
.................................................................................................................................................................
61
B.
Job
Descriptions
...................................................................................................................................................
61
1.
Executive
Director
.................................................................................................................................................................
61
2.
Social
Worker
..........................................................................................................................................................................
62
3.
Nursery
Manager
...................................................................................................................................................................
63
4.
Services
Coordinator
..............................................................................................
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not
defined.
5.
Caregiver
...................................................................................................................................................................................
64
6.
House
Parents
............................................................................................................
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not
defined.
7.
Cook
.............................................................................................................................................................................................
65
C.
Qualification
Standards
.....................................................................................................................................
67

D.
Community
Resources
.......................................................................................................................................
67
IX.
Budget
.........................................................................................................................................................
68
A.
Sources
of
Funding
2012
...................................................................................................................................
68
B.
Financial
Statement
2012
-
Summary
of
Income
&
Expense
...............
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not
defined.
C.
Financial
Forecast
–
Two
Year
Plan
...............................................................................................................
68
D.
10
year
Plan
...........................................................................................................................................................
69
A.
Supervision
............................................................................................................................................................
71
B.
Monitoring
.............................................................................................................................................................
71
C.
Evaluation
...............................................................................................................................................................
72
XI.
Reporting
and
Recording
System
......................................................................................................
73
A.
Records
and
Files
.................................................................................................................................................
74
B.
Medical
....................................................................................................................................................................
76
C.
Counseling
and
Meetings
..................................................................................................................................
76
D.
Financial
................................................................................................................................................................
76
XII.
Annexes
....................................................................................................................................................
79
Employee
and
Volunteers
Manual
......................................................................................................................
79
DSWD
Endorsement
................................................................................................................................................
79
Organizational
Chart
...............................................................................................................................................
79
Foster
Parent
License
.............................................................................................................................................
79
Agency
Forms
............................................................................................................................................................
79
Employee
and
Volunteers
Manual
..........................................................................................................
80
A.
Volunteers
..............................................................................................................................................................
80
B.
Interns
.....................................................................................................................................................................
82
C.
Regular
Staff
..........................................................................................................................................................
82

D.
Work
Days,
Day
Off
and
absences
and
Leave
Privileges
........................................................................
82
G.
Training
and
Development
..............................................................................................................................
84
H.
Dismissal,
Termination
and
Disciplinary
Actions
....................................................................................
84
I.
Home
facility
Policies-Staff
involvement
......................................................................................................
85
GENERAL
ADMISSION
FORM
.....................................................................................................................
87
CHILD
INTAKE
FORM
...................................................................................................................................
89
PARENT
INTAKE
FORM
...............................................................................................................................
94
BIRTH
CERTIFICATE
DRAFT
:
...................................................................................................................
97
PANAWAGAN
1
...........................................................................................................................................
100
PANAWAGAN
2
...........................................................................................................................................
102
PHYSICAL
EXAMIN
&
MEDICAL
HISTORY
OF
CHILD
.......................................................................
103
CLOSING
SUMMARY
FORM
......................................................................................................................
105
PHYSICAL
EXAMINATION
&
MEDICAL
HISTORY
OF
CHILD
..........................................................
107
MEDICAL
CERTIFICATE
............................................................................................................................
109
PHYSICAL
EXAMINATION
REPORT
......................................................................................................
110
CERTIFICATION
of
Immuniztions
.........................................................................................................
112
CHILD
ADMISSION
HEALTH
INTAKE
...................................................................................................
114
J
O
I
N
T
A
F
F
I
D
A
V
I
T
........................................................................................................................
116
C
E
R
T
I
F
I
C
A
T
I
O
N
of
Appearance
......................................................................................
118
FOR
PUBLICATION:
Abandoned
Child
................................................................................................
119
Minutes
of
Admission
Conference
.......................................................................................................
120
TRANSMITTAL
MEMO
..............................................................................................................................
123
A
U
T
H
O
R
I
Z
A
T
I
O
N
................................................................................................................
125
Visa
Medical
Expense
Form
....................................................................................................................
126

DEFERMENT
SLIP
.......................................................................................................................................
128
Medical
Records
Clerk
..............................................................................................................................
130
D
I
S
C
H
A
R
G
E
F
O
R
M
.........................................................................................................................
132
JOINT
AFFIDAVIT
.......................................................................................................................................
134
JOINT
AFFIDAVIT
.......................................................................................................................................
136
C
E
R
T
I
F
I
C
A
T
I
O
N
..............................................................................................................................................................
138
MEDIA
CERTIFICATION
............................................................................................................................
140
To:
The
Radio
Announcers
.....................................................................................................................
142
D
E
E
D
O
F
V
O
L
U
N
T
A
R
Y
C
O
M
M
I
T
M
E
N
T
..........................................................................
146
C
E
R
T
I
F
I
C
A
T
I
O
N
Structural
Safety
.....................................................................
149
KATUNAYAN
1
.............................................................................................................................................
150
CERTIFICATION
..........................................................................................................................................
151
Initial
Family
Assesment
Form
..............................................................................................................
152
Evaluation
of
Worker-
Name:__________________
....................................................................................
155
C
E
R
T
I
F
I
C
A
T
I
O
N
of
Discharge
......................................................................................................
157
GENOGRAM
CHECKLIST
...........................................................................................................................
158
RELATIONSHIP
AND
INDIVIDUAL
FUNCTIONING
QUESTIONAIRE
............................................
161

Introduction
7
I.
Introduction
Aloha House is a non-stock, non-profit, charitable mission organization
serving the community of Palawan and the nation of the Philippines, fully
licensed by the DSWD as a Child Caring Agency, Child Placing Agency and
Community Serving Agency under License No. 01-IV-022. Accreditation
#SB-2002-016
A. Historical Background
Aloha House started as a ministry base for Keith Mikkelson in July of
1998. He moved to the Philippines in May of 1998 to help the children of
Palawan rise above the tough living environment in this last frontier of the
Philippines. He believes the bible is the only true guide in helping man out of
his social predicament and uses biblical principles that are contextualized
for the Filipino setting. He has made trips to the Philippines in 1995, 1996
and 1997 previous to his move here. He visited local churches that exposed
him to the needs of the indigent community, some of which resided in
squatter areas and tribal groups. He also visited orphanages in Luzon,
Negros and Japan. Many times he met people with sad stories about the
living conditions and parents whom where not able to cope. Teaching the
gospel of the Lord Jesus Christ and showing the love of God toward the
neediest children and families is Keith’s idea of the normal Christian life.
While meeting with a Social Worker with the City Social Welfare and
Development Department, CSWD of Puerto Princesa City, he was given the
vision of starting a home that could help these children in some way. She
already had two foster children. She was raising a tribal boy whose mother
died upon giving birth to him and a foundling who was thrown in the trash
after his birth. Mrs. Yulo, City Social Welfare and Development Officer,
CSWD, was also very supportive and offered valuable information. Mrs.
Remy Beltran, Department of Social Welfare and Development (DSWD),
Region 4 also gave information about child welfare care agency status.
After much research, prayer and encouragement from supporters in
the US, he moved to Puerto Princesa City in May of 1998, to start

Aloha House Inc. Manual of Operation
networking with various Christian groups and social workers. In March of
1999, Keith Mikkelson was married to Narcisa Bolasa. There was a lot of
interest and support in the Christian community in Puerto to help the
children in crisis. So on May 11th, 1999 a Board of Directors was formed to
incorporate the name of Aloha House Inc. as a non-stock, non-profit, Non
Government Organization (NGO), The Securities and Exchange Commission
in the Philippines issued a Certificate of Incorporation, Reg. No.
A199906202 for Aloha House Inc. The board meets quarterly to discuss
the needs of the children and Organization.
8
As a step of preparation, Keith and Narcy Mikkelson became licensed
Foster care parents in June of 1999 by the DSWD (License No. 00-134).
Arlene Panes, Social Welfare Officer II, Region 4, helped manage the cases
in their care from her Department. Keith and Narcy have taken in various
children with diverse needs. They have foster parented infants in crisis
and children abandoned by their parents. They have also cared for sexually
abused girls and pregnant women in crisis. They trained a staff of women
who are good at working with children. They also hired a full time licensed
Social Worker, Cristina Velasco in February 2000. They are consulting the
DSWD on a continual basis to meet the children’s needs.
In April of 2001 Aloha House passed inspection by Elvira Colarina
SWO IV, Region 4. On April 23, 2001 Aloha House was issued a license as a
Child Caring Agency, Child Placing Agency and Community Serving
Agency under License No. 01-IV-022.
In February, 2002 Aloha House passed a technical review for
accreditation by the Bureau of Standards, by Mrs. Chat Pallarca.
Accreditation #SB-2002-016. After 11-years of operation, we have
achieved the Second Level accreditation standards. We hope to reach and
pass the Third Level accreditation as we continue to evolve and learn to
improve our management skills and the services we offered.
Aloha House is now located in Santa Monica in Puerto Princesa City on
Mitra road. We moved in December 2003. The facility is completed and we

Introduction
have a permanent home for our temporary clientele. It has good air flow,
room for playing and a garden producing a variety of food items. After
renting for almost five years we are thankful to God for His provision of
our home for the children and staff.
9
Many of the children in Aloha House would have died if we weren't
able to intervene in their lives. We thank God for our ministry partners
whom pray and support us, we are a team working to help children and
families in desperate situations here in Palawan. We currently one Licensed
Social Worker, 4 Caregivers, a Full-Time Cook and 2-Assistant Cooks, 2-
Laundry Housekeeping, and 8 Farm Staff, 1-Livelihood Assistant and 1-
Admin Assistant. The Mikkelsons are full time volunteers and direct the
affairs of the house and staff and act as house parents as well.
Since Aloha House moved, the flow of visitors has been steady. Many
are curious of the signboard and others want to know who grows the big
papaya fruits they can see from the road. Sign ups for training are
increasing and it keeps Keith on his toes. We conduct seminars and training
on Sustainable Agriculture. This led for an opportunity for Keith to speak
at an environmental council of the City Government to talk about the
Effective Microorganisms' effect on wastewater treatment for odor
control of a processing plant for marine products. We also do Farm
Internship Program.
Vegetable Production Taking Off - We have added workers in the
garden. And we have acquired a bigger property to expand our operation.
As the pool of farm workers grows, our farm production has also
increased. We are now selling extra produce that we cannot store. The
extra tomatoes we are producing are sun-dried or made into fresh salsa.
Squash and sweet potatoes that have no blemish store well and can be used
later. Other produce are being processed and sold in supermarkets and in
our Farm Store. We have regular customers and establishments being
supplied with our fresh farm produce and processed goods. It is exciting
to see the farm beaming with different colors of fresh produce. And in all
of this, we want to honor the Lord of the harvest who has blessed us with

all the food and the strength and wisdom to share to others so they too can
be productive and succeed in supplying for their family.
B. Rationale
According to the National Statistics Office, 32% of all Filipinos live below
the poverty line with an annual per capita income of P 11,000 ($200.00).
The N.S.O. reported that 75% of them were also hurt by the El Nino
weather. In addition, according to the last census, families with 2 or more
children in Palawan live in a shelter much smaller than the national average.
These factors combine to make living conditions very difficult and it is the
children who suffer. Many are abused and neglected because of a
combination of these factors and mankind's tendency toward evil.
Parenting is hard work. If parents are selfish or lazy then their children
will suffer.
10
According to the Mayor’s office in a report on Puerto Princesa City’s
Master plan:
The infant mortality rate is currently 16.82.
31% of all households have newborns with weight below 2.5 kilos.
29% are not immunized.
35% do not have access to potable water. (250 kilometers or 10 minute
walk)
34% have no sanitary toilet. 43% have no preschool.
37% are not in high school. 9.2% of the road network is paved.
Only 49,000 out of 123,000 homes have power.
Children are abandoned to relatives and sometimes thrown in the trash or
aborted. The children of the Philippines who end up on the streets come
from homes that have lost their struggle to be a family. Children from

Introduction
squatter areas and tribal groups as well as transients and single parents end
up victims of negligence or unprepared parents. The case of baby Jas
thrown into the trash in Puerto Princesa City points to the need of a facility
that can place children in crisis without families into the permanent care of
qualified families. In the Metro Manila area, House of Refuge is creating a
home environment for children. In Bacolod, Calvary Chapel watches over
children in the hopes of returning them to their families. In Rainbow
Orphanage, Dumaguete City, the children are placed in families through
adoption. Everywhere we have been, we see concerned citizens and
missionaries with the desire to help the children around them.
Many times we have met people with sad stories about their living
conditions and parents who where not able to cope. We have started with
those children who have no known family or are surrendered for adoption.
We plan to operate multiple orphanages and facilities that will help children
in crisis without families; abandoned or surrendered, as a licensed child
welfare caring agency according to DSWD regulations. We believe placing
them into qualified families is the best way to help. Republic Act 8043
states that each child has a right to a family of his own.
Those that are younger readily place into families according to the laws of
this country. That is why we started with the youngest, neediest children.
As we grow in experience and knowledge and develop competent staff we
will expand our services to older children, hence the newly acquired
property. On a case-to-case basis, unwed mothers are also able to benefit
from our services. Knowing that many abandoned children come from this
sector, we plan to meet immediate needs as well as work through
educational programs and livelihood projects to prevent some of the
growing problems in the area. It is possible to take one step at a time and
monitor the effectiveness of each program that is implemented. With
spiritual counsel and moral training according to God’s design, these women
can change the destructive patterns in their lives.
11

II. Mission and Vision, Goals and Objectives
Vision
Our vision is to see healthy families and their children become a
benefit in society.
Mission
It is our Mission to help children families and communities, physically,
mentally emotionally, and spiritually.
A. Goals
It is our goal to establish high quality child welfare care agencies that
cater to the needs of children.
It is our goal to promote the welfare of needy children, emotionally,
physically, mentally, and spiritually.
It is our goal to contribute to the development of impoverished
communities through sustainable agriculture programs.
B. Objectives
As stated in our Articles of incorporation, we resolve:
1.) To operate facilities that will help children who are 0 – 3 years old:
12
a. in crisis
b. without families
c. abandoned
d. surrendered

Mission, Goals and Objectives
13
e. to eventually cater to older abused girls
as a licensed child welfare care agency according to DSWD
regulations.
Abused Children, Abandoned and Surrendered Children, Street Children
Abused Children
Some children need a safe place to wait or to heal while their abusers
are investigated and prosecuted. Many times it is a family member or
neighbor. Often, they must be removed from their homes. In 1998, prior
to the opening of Aloha House, the number of cases reported to DSWD in
Palawan totaled 54. This figure was already reached in the first quarter of
1999 when Aloha House started taking in children on Foster Care. Aloha
House started accepting referrals from the CSWD and DSWD. Most of
them were abused cases. We offer a home school curriculum approved by
DepEd (Department of Education). We also offer counseling and a home
where the child can heal and find stability.

Abandoned and Surrendered Children
14
The United Nations Convention on the Rights of the Child and the
Philippine Republic Act 8043 state that every child has a right a family. It
is our intention to legally place younger children into loving families
approved by the Philippine government. This will be through local adoption
procedures as well as the Inter-Country Adoption Bureau, or ICAB. We will
eventually open a facility that would be a home for children who are not
readily adopted.
Street Children
Street Children are a growing problem in larger cities and we plan to
help with drop in centers and specialized facilities for long term care when
staff is trained and funds permit.
2.) To engage in community-based-services such as Feeding Programs for
malnourished and undernourished children, Medical Missions in needy
communities, Scholarships for less privileged children and Livelihood
programs for impoverished families and conduct of training on Sustainable
Agriculture practices.
Besides helping children in crisis, we like to help troubled families.
Many of the children who are abused, abandoned or surrendered could have
stayed with their original family if preventative steps could have been
taken. It is our plan to develop programs that give families a hope and a

future, equipping them as well as providing for them some of the most basic
needs in life.
We have sent one recent high school graduate to MSU, Mindanao, on a
15
support scholarship. She is from the tribes and eager to learn.
We have done various feeding programs in the community as well as
livelihood projects.
3.) To assist unwed mothers through counseling, care and other
assistance programs.
Because of the growing temptations of our modern society, many
women are confronted with parenthood before they are ready. A young
single girl in crisis pregnancy is under enough shame from her surrounding
friends and family that abortion or illegal abandonment becomes a way of
escape. With a network of campus faculty and students working on behalf
of the unborn children, we could prevent some of the tragedies that are

occurring in the High schools and colleges here through abortion. This is
genuine pro-life mission.
16
Mothers with Hope is our program that aids some of these women
when the needs are not met from partners, family, the government and
other private sectors. We offer counseling and encouragement while at the
same time we require a desire for change. We can assist with proper
housing, child delivery and even adoption in the case of rape or
abandonment. We also require that the ladies in crisis pregnancy work to
their level of ability till they deliver, offering livelihood training for life
outside the institution.
4.) To conduct sustainable agriculture training to answer the increasing
needs for safe and nutrient dense food.
Sustainable Agriculture and Farming Training is a way for mothers
and families to supply the basic needs of children on a continual basis. We
believe that a big contributor to the strength of a nation depends on the
health of its people. We have ongoing training and internships available for
those who desire to change and eat nutrient dense and healthy foods. This
is also part of our community service. The trainer cost is free. The
participants pay for the material and food cost and cost of electricity and
other incidental costs. In the past, we have trained thousands in a given
year but few are actually applying the training they received. Aloha House
served food and gave out materials for free. After evaluation, we figured,
that for Filipinos, anything free is synonymous to being less valuable. When
we charged for material cost and food cost, people who came for the

training are those dedicated and serious farmers. They are the ones
committed to apply what they learned and we were able to sift the curious
from the serious participants. Now the training becomes valuable as it cost
the participant to get it.
17
5.) To develop educational programs for our clientele as the needs arise.
Education is important in breaking the cycle of poverty and abuse that
is prevalent in today’s society. We believe that bringing knowledge to the
clientele we serve is not enough. It takes genuine application of things
learned that create change for struggling families. The material taught
must be true and work for people to see results from their education. Each
child and family we can help down the path of better education will benefit
themselves and society as a whole.
Some of the programs we aim to develop can include the
following:
a. Educational programs for adult and child literacy

18
b. Educational programs for preschoolers
c. Educational programs for livelihood
d. Educational programs for formal education when we
grow to a size that would make it favorable.
C. Philosophy
1.) We believe that each child is a precious gift from God and
that man’s total development of his/her well-being must be the concern of
our organization.
2.) We believe that each and every child has the right to belong
to a family.
3.) We believe that society has the obligation to assist and
strengthen the family. In the absence of a family, there is a need for a
good, safe and secure home to love, care and shelter children.

4.) We believe that with love, care and a good education a child
can grow and serve their own country and someday provide a loving and good
home for their own family.
5.) We believe an institution is better than a life of neglect and
19
abuse, but a family is the best place for a child’s development.
6.) We believe that the health of its people contribute to the
strength of a nation.

III. Clientele
20
Our target clientele are children in crisis, unwed mothers, abused
girls and families in communities desiring to grow their food, and depressed
communities. Our initial target group is twofold. We will take in babies and
young children who we can be placed into qualified families through legal
adoption. Older children who suffer abuse could be sheltered on a short-term
basis in limited numbers. Initially, these two groups could combine in
a family environment.
We would then develop a separate children’s home for girls who are
abused and in need of short term care. Also, we are conducting feeding
programs through local volunteer groups and churches for malnourished and
undernourished children, as well as medical missions in needy communities.
We will raise funds for scholarships for less privileged children and develop
livelihood programs for impoverished families. We also help unwed mothers
in need of counseling, care and other assistance programs. Later, unwed
mothers would need a separate facility. Finally, street children would be
helped with drop in centers and a halfway home to help them prepare for
regular family life.
For the Community service, our target clientele is wide. They are
from community groups, to individual farmers to unwed mothers, to
students and employed people both government and private. At this time
of spiraling food cost with agricultural inputs soaring, we see all the more
the need for people to learn how to farm in a most sustainable and safe
way.

Clientele
The medical outreaches and feeding programs and community
outreaches we are doing are all targeting depressed area within the city
and communities in Palawan. We are coordinating with the City Health
Office, Barangay Officials and Community leaders with the help of our
volunteers from outside the country and professionals in the Province who
donated their time and expertise.
21

22

IV. Geographical Area of Coverage
24
Region IV-B is our target area. We are taking referrals from other
parts of Region IV-B, as well as other regions in the Philippines.
The environmental areas targeted would include but not be limited to places
such as slums, squatter areas in the cities and mountainous rain forest
communities, especially where the people are living in poor and miserable
conditions. These are the people just barely existing with little hope of
change and without help.

General Policies
V. General Policies
For Aloha House to run properly, rules and guidelines are a requisite to
govern it’s operations. Thus, it is a must that everyone who would be under
this agency would be required to conform to its policies. The board and the
administrating staff make decisions and set up the policies for this agency.
The staff has the responsibility to adhere to such guidelines, rules and
regulations as necessary in maintaining a good environment for all. All
policies are for the children's best interests.
25
A.) Service Policies
1.) Types of Care
Our level of care will expand as we train staff and build our
support base for financial operations.
a.) Phase 1
Temporary care – care and shelter for (6) six months but
not more than (1) one year if necessary on a case to case
basis, for any child needing temporary shelter or care due
to:
! family breakdown
! abuse
! financial crisis
! medical problems (case-to-case basis)
b.) Phase 2
Permanent placement care - any child needing permanent
placement due to:
! surrender or abandonment
! family reconciliation may never be realized

26
c.) Phase 3
Long term care ( on a case-to-case basis) - any child
needing help due to:
! special shelter from abusive parents
! extreme poverty
! a special need (case-to-case basis)
2.) Child Eligibility
a.) Any and all children:
! age 0-16 years old
! male or female
! all races and religions
b.) Children referred by:
! DSWD
! the police
! parents
! concerned individual
! authorities
! any other agencies

General Policies
27
B.) Admission and Intake Policies
We wish to make our clients welcome and accepted
1.) Child:
! staff will welcome him or her
! make the child feel comfortable and loved
! meet any emergency needs
! feed a nutritious meal and give a bath
! provide clean clothing
! medical examination by our physician upon in-take
2.) Accurate records and forms:
(Always make sure you have the appropriate forms)
Necessary things to do before admission:
! interview the person referring the child
! interview the nearest kin
! fill out intake conference form for signature
! interview any one involved
! an informal interview is made with the child
! any details observed are noted
! facilitate medical exam and get medical history
thoroughly
! have a case conference with at least two others in
the agency
! document the interview in writing and in tape
recorder

28
3.) This is the policy of referrals from other
departments and facilities. To be submitted upon admission of
the referred client:
• Referral letter with specific time frame
• Case study report and/or case summary department’s
treatment plan
• Birth certificate
• Medical certificate
• Immunization Record
• General Intake Sheet
In the absence of any of the above documents, referrals could
still be accepted on a case to case basis, provided that a
promissory note will submitted by the referring social worker
that such document/s will be submitted in two weeks time after
the client’s admission.
C.) Child Care
a.) Any and all children:
! initial target 0-3 years old
! considered age upon expansion is 0-16 years old
! male or female
! all races and religions
b.) Children referred by:
! DSWD
! parents, concerned individual

General Policies
29
! authorities or the police
! any other agencies

30
D.) Community Outreach
After conducting an ocular inspection followed by an actual
survey using our survey tool (see annex), we will conduct
outreaches that will bring help to those in need. As in the past, a
Medical Outreach might be appropriate or a Feeding Program or a
Literacy Program, or Livelihood Program. We will strive to work
with families in crisis as well as children in need.
1.) Feeding centers
! contact local groups already in area
! network with existing agencies
! delegate resources when quality programs can be
co-developed
2.) Medical Programs:
! assign medical professional to oversee/consult
! secure government clearances
! screen volunteers that will assist in medical
programs
! contact local groups already in area
! network with existing agencies
co-developed
3.) Livelihood Programs

General Policies
! develop a time table for project ideas and write a
project study for viable and appropriate projects
! network with businesses and possible government
agencies for collaboration
! contact local groups for assistance in implementing
the program
co-developed
31
E.) General Policies for Unwed Mother’s Program
Based on two things, an unwed mom will be accepted in the
Mother’s With Hope Program:
1. After Assessment and evaluation of the case of the
concerned unwed mom where the Agency finds that its
services and help is indeed necessary;
2. The unwed mom expressed her desire to be helped on the
terms laid out by Aloha House based on the following:
! Treatment Plan
! Skills Evaluation
! Signing of agreement between Aloha House and
the client
! Regular monitoring and evaluation by Social
Worker
! (refer to details of the program in the Annex)

32
F.) Administrative Policies
1.) Volunteers
Volunteer workers have no employee/employer relationship with
Aloha House. Usually the person is able to come and go as they desire. In
some cases a small amount is available for reimbursement of expenses.
Foreign volunteer workers should pay their own travel expenses,
board and lodging and should have pocket money. Aloha House will serve as
a training ground for the volunteers to prepare them for future ministry in
line with child-care, community work and agriculture training. (See Aloha
House Employee & Volunteer Manual/ Section VII: Annexes)
2.) Regular Staff
! All wages are to be reported to the S.S.S. and the
B.I.R. and PhilHealth.
! All forms and background checks and references
will be received first
! An interview will be made before hiring
! Person must understand Rules and Guidelines (see
Annex) and be willing to abide by said rules
! The staff will serve as good, moral and loving role
models for all the children in their care as well as
the community. They must display respect,
honesty, diligence and fear of God.
3.) Work Days, Day Off and absences

General Policies
! Regular scheduling will be set by the Director
! Hours served as volunteer are not counted toward
regular hours
! Some duties may allow for split shifts
33
4.) Leave Privileges & Other Incentives
! Vacation leave is offered after one year of
employment.
! Leave is available without pay for personal reasons
! Sickness pay may be available through SSS
! Maternity Leave is available through SSS
! 13th Month Pay Privilege
! Bonuses are given to employees involved in the
Livelihood Programs
! Retirement and Separation Fee when applicable
5.) Training and Development
! Ongoing training through Bible Studies, regular
staff meeting and evaluation will be available to all
staff on a regular basis.
! Programs from the DSWD and other training
opportunities will be utilized for staff development
! Training will be offered for technical, social and
spiritual development as well as child care service
6.) Dismissal, Termination and Disciplinary Actions
Staff will be dismissed for:

34
! Crime
! Concealment, dishonesty
! Drinking alcohol on the premises
! Fraud
! Gambling
! Neglect of duties
! Immorality
! Insubordination
! Misconduct
! Smoking
! Drug use
! AWOL
! Abused to children
• Violation of any rules may result in immediate
termination.
• A clear explanation must be given to the worker for
their termination.
• Verbal warnings and (2) two written warnings can be
used before suspension and / or termination.
G. Home Facility Policies-Environment
1. Aloha House has provided the children’s home with a clean,
sanitary and safe environment well suited for a child’s
upbringing.
2. Aloha House has complied with all the requirements listed
below and in accordance with all the existing laws and ordinances
of the government:
! Careful selection of staff
! Fire safety compliance

General Policies
35
! Health laws
! Home maintenance
! Labor laws
! Water filtration

H. Child Protective Policies
A. General Guidelines – The Agency
will adhere to existing laws and rules
for the protection of the child and
will adapt measures as follows for
the protection of children:
Preventive Measures
• Public policy
(codes, laws)
• Pre-marriage counselling
• Early childhood care projects
• Public education and awareness
raising
• Parent education
• Family enterprises
• Self-enhancement services
• Counseling
• Behavior modification techniques
Clearly, the prevention of child abuse/maltreatment is everyone’s duty. It
involves the active participation and cooperation of the government, non-government
36
organizations, the private and business sectors as well as the
community and families. It entails the creation of an environment that is
conducive to healthy, bright and productive children who will be the
global citizens of tomorrow.
• Thorough screening of employees and staff before hiring
Corrective Measures: (Disciplinary & Legal Measures)
• It is the responsibility of the agency to respond accordingly to
erring staff committing child abuse. It is mandated by our
Employees Manual that child abuse is a grave offense and

General Policies
37
therefore will result to disciplinary action if not legal action.
• The erring personnel, volunteer or intern will be dealt with
according to what the law requires and mandated and if necessary
within the due process of the law.
I. Child Discipline Policies
1. Explanation
a.) Discipline encompasses the systematic maturing,
regulation and guidance of physical, moral and spiritual
attributes and values of a child including the control of
those factors that can deter or foster his/her behavior
and development.
b.) Discipline needs to be exercised for a healthy
approach to a child. It should yield love, respect and good
behavior in the child. Desiring a world of joy, trust and
love, the children and staff become willing partners in the
life of the home. Consideration for individual differences
and personalities of each child towards their social and
emotional maturity is important.
c.) Children thrive best in an atmosphere of genuine love
under girded by reasonable, consistent discipline. They
need help and assistance in learning how to face the
challenges, difficulties, disappointments, heartbreaks and
obligations of living in this world. They must learn self
control and should be equipped with the personal strength
needed to meet the demands imposed on them by their:
! Family

38
! School
! Peer group
! Work assignments
! Community
! Adult responsibilities
In the days of widespread drug use, immorality, civil
disobedience, violence and vandalism, the home must
fashion the right attitudes for moral values on a child
through consistent discipline.
d.) Any consequence must be logical. Making sure the rules
are clearly seen, understood and explained in advance will
eliminate many discipline problems. It must be clear what
is acceptable behavior.
2. Forms of Discipline and Desired Results
a.) Forms of discipline
! Caring and cleaning of personal belongings
! Caring and cleaning of house, garden
! Cleaning room, cabinets
! Good hygiene and health
! School responsibilities
! Counseling
! Time-out (1-15 minutes refection)
! Removal of undesirable situation
! Firm correction
! Diversion from unacceptable behavior

General Policies
39
b.) Desired results
! Respect
! Obedience
! Politeness
! Courtesy
! Self-control
! Moral decision making
! Love
! Responsibility
! Industriousness
J. Health and Feeding of Children
1. Rationale
At the early years of our operation, we have been swamped with
seriously malnourished and sickly children. As we studied and
researched means and ways to nourish these children back to health,
we discovered that the most effective way to accomplish this is to
feed them with only the most nutritious food coming from its most
natural source. The frail and sickly body should easily absorb the
food without any preservatives or additives. In short, we give them
the minerals and vitamins they need from fresh fruits, fresh fruit
juices, fresh vegetables (as much as possible organically grown), and
unpolished rice, whole grains and the like. We have our own juicing
machine to extract juice from fresh fruits, soya milk maker machine,
food processor machine and a varied list of gadgets to make food for
the babies and children from scratch.

40
2. Experience
Our labor and the expertise of the kitchen staff have paid off.
Third degree malnourished children have recovered in a short time.
And we are proud to say that except for standard and required
medical check ups, we do not spend money for hospitalizations or
medications for the children unless they have come with sickness
already and needed medical treatment.
3. Visa Medical Travel for international adoption
Aloha House prefers to buy food in Manila and when possible
would prefer to prepare the children’s food when the babies go for
their visa-medical clearance. We buy quality, proven, safe oils, fruit
juices in the malls and we buy groceries when we do the medical
examinations, to give the children the food they are used to - foods
that are not tainted with MSG and other food additives, high salt,
toxins and preservatives. It is more inconvenient but no more costly
in the long run. This is the policy of our agency. Normally, we pack
everything we need for a day or two and bring everything we need.
But when the medical examination is extended, it is inevitable to buy
and prepare the food as we are used to.
4. Adoptive Parents
We know that people will see the wisdom in this nutritional
program, as does the medical community. The adoptive parents always
appreciate the extra care from Aloha House. It is our aim to see our
clients build a healthy foundation at a young age and most parents
follow through with our nutritional plan.

Adoption
41
VI. Programs and Services
Aloha house programs are designed to meet needs that are holding
back children and families from healthy growth. Some programs are
preventative. Others only help with relief of the symptoms of bigger
problems that the children experience. We oversee some programs with
other groups and also network with organizations already active in social
welfare. We have a total human resource development approach. The
programs and services rendered by Aloha House will enhance the
development of the total person. We will take the responsibility to do
everything possible to provide quality programs and services that will bring
a hope and a future to our clientele. We offer God’s love through the
Gospel of Jesus Christ.
A. The Permanent Placement Program
Those children qualified for legal adoption locally or through ICAB will
be facilitated by our staff in compliance with all rules stated in the
Family Code of the Philippines, Presidential Decree 603 and any other
requirements that the laws set forth for the welfare of children.
1. Local Adoption
It is a mandated priority to locate potential adoptive parents
locally. If none are qualified the search is broadened through out the
country. Child caring institutions that can place children for adoption
are licensed through the Department of Social Welfare and
Development (DSWD). No private adoptions can be done but all
children who will leave the country for adoption must go to the Inter-
Country Adoption Board (ICAB) in Manila. This is a branch of the
DSWD. It is not possible to adopt a child directly through an
orphanage and you cannot request a child from a specific orphanage if
you are abroad.

42
2. Steps to adopting a child from the Philippines:
Step 1 – Contact an adoption agency
People interested in adopting a child in the Philippines must first
begin with contacting an agency in their home state or country that is
licensed to work with the Philippines. If you gave as your location in
the US or other Countries we can give you addresses of agencies in
your region.
Step 2 – Preparation for Home Study
After you have found an agency to work with they will complete
a home study. Your case study is then sent to the Inter-Country
Adoption Board in Manila and is approved by this office. Once
approved your name is put on a “family roster” with all other
applicants from around the world.
Stop 3- Matching Process
When an institution has a child ready for Inter-Country
Adoption they review the roster. They read the case studies of
families that meet the profile of their child who is being matched. For
example, if they have a 3 year old boy who has had TB and suffered
from malnutrition, they pull the files of families who are asking for
this age, gender and who will accept his medical history. Once they
find a family who fits their child’s needs, that family is presented to a
“matching committee” who then gives their final approval. The
paperwork is then sent to the agency you are working through back
home. The adoptive family gets to read a case study about the child
and then must make a decision to accept or deny the match.

Adoption
Step 4 – Travel Documents
Once you have accepted a child for adoption, any needed
visa/medical exams, travel document, etc., are prepared on this end
and completed before your arrival in the Philippines. Children undergo
a visa-medical exam for clearance to travel to their new country.
Step 5 - Getting your child
It is a requirement by the ICAB that adoptive parents travel to
the Philippines to be united with their child. Most families spend
about one week here in the Philippines. This allows “bonding“ time with
your child and also time to finish any needed paperwork with ICAB.
Step 6- Financial Responsibilities
Fees vary from agency to agency. We are not part of the
financial arrangements with adoptions. Your agency should be able to
give you accurate information on all fees for adoption through the
Philippines. The children’s homes and orphanages have no fees or
charges accrued to the adoptive parents. They operate as a charity.
Step 7- Completion of Adoption
Once your child is home, your agency will complete the necessary
follow up reports and guide you in the final legal work for the adoption
of your child in your own State/Country.
43

44
3. Bonding
Families are required to transition into their new role as parents
and siblings by going through a 3 day minimum bonding process. This
assures the child that they will be cared for and will adjust through
the rigors of travel an new surroundings as well as new and permanent
care givers.
C. The Community Outreach Programs
Not all needy families will benefit from the services of Aloha
House directly. We are always trying ways to help the members of
the community around us. The idea is to help some families before
they become problems, giving encouragement and guidance.
1. Feeding centers
We have a six-month program that is with different Christian
ministries that feed children and do evangelism on a weekly or
monthly basis. A nutritious meal is provided and children in the
community are taught Bible stories and songs and games. One
group used our funds to feed their pre school students who
attend free classes. Currently we are developing a sustainable
feeding program where tribal families are taught nutrition and
given cooking utensils. They are given seeds to plant for the
ingredients to the nutritious recipes that missionaries teach
them.
2. Medical Missions
We have donated funds to various projects run by medical
workers for preventative health care. They will develop their
program with the funds we donate to their ministry. We also co-ordinate
families in our outreaches to receive free medical care.

Adoption
45
3. Community Training
We will also use experts in the community to teach hygiene, food
handling/nutrition, parenting, proper care of children and
gardening to the target areas that we identify. Low cost
sustainable agriculture is one of our weekly free trainings
available to the community. See Appendix for Sustainable
Farming Manual.
4. The BARANGAY HOPE
Each outreach coordinates funds from the US to meet the
physical needs of the poorest communities in the cities and
tribes. We work with local churches already serving the area
with the gospel of our Lord Jesus Christ. We invite government
officials to partake in the outreach, showing the communities
that they care and are working for their needs at all levels of
government.
“Assessing the needs of a community and giving help that will
bring change”
" House to House Surveys
" Family Assessment
" Short term aid
" On going assistance
Each Barangay has it’s own unique problems depending on it’s
membership. Many settlers in the city cluster together because
they cannot afford to pay rent or buy land. They build homes on
stilts over the water or settle on undeveloped land. These are
some of the neediest families in each Barangay. These are the
families we have targeted to help.

46
Barangay Hope is a way to assess the needs of the community
and involve government officials at higher levels to partake first
hand, in helping with the needs of the people.
First, we locate a community where a local Christian church
is committed to helping. Then we assess and qualify families.
Then we hand out invitations for the outreach to each family in
the target area, stating that we care and want to help. Then we
invite government leaders and the media.
On the day of the outreach we will share the gospel of
Jesus Christ and then give each family supplies, food and other
necessities they normally cannot afford. The government
officials take part in the distribution of the supplies for these
families. Each official will personally hand them the rice sack,
clothing, towels, etc.
The government officials are blessed in giving to their
people and get to meet them personally. The Gospel is preached
and seeds are planted. The local church disciples new believers.
The sponsor, Aloha House Orphanage, through our staff social
worker, is able to locate abandoned and neglected children that
need continued help.

Adoption
47
5. The School Program
A. Rationale & Objective
The current target clientele of Aloha House is 0-3 years old.
However, this agency does take in on a case-to-case basis, older
children. We will also be helping older children as we expand services
and facilities. There are also clients that have grown older and their
cases have not moved on due to slow judicial and/or complicated paper
work. Other times we take children in the middle of a school year and
children that could not be placed in a regular school because they are
being stalked. Sometimes they are too old for their level and hence
ashamed to go to school.
With this in mind, we put up a Homeschooling program to
address the educational development needs of our clients. We plan to
develop an entire school system as we grow.
The toddlers have a daily schedule (9:30 – 11:00 in the morning)
of coloring, pre-reading activities, learning songs and other play-school
activities. This helps the children develop not only mentally but
hone their fine motor skills as well.
B. The School Curriculum
The School Of Tomorrow Homeschool Program uses the
Accelerated Christian Education (ACE) Curriculum. It is accredited
by the Department of Education. The materials are quality
educational tools and the child learns at his pace. The child can also
bring the materials when she leaves Aloha House hence; his studies
will not be cut-off because the parents can continue to supervise the
homeschooler. It is a US standard curriculum and to fit the needs of
the Filipino child, they added Filipino and Sibika at Kultura courses so
when the child will be placed in a Filipino home, he will not be lagging in
the Filipino Educational requirements too.

48
C. Other Activities of the Homeschool
Field Trips - we believe that exposure to actual daily activities
and different surrounding is a good teaching tool. The child is able to
bridge and connect what he learns from books to actual life and he is
able to apply it real life situations.

Sustainable Agriculture
Outdoor Sports Activities - Kayaking, Biking and Swimming and Hiking are
activities we expose the children to.
School Outing – fun times like picnics and beach outings are also
included once every two months.
School Breaks – School breaks are after every semester (Five
Months), Christmas Break, Summer Break and if the child finishes his
PACES ahead of schedule because of diligence and hard work then he
is rewarded with an extra three day to a week of school break.
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6. The Mothers with Hope
A. Rationale & Objective
Single mothers often have little hope for change. When relatives
are not able or willing to help they don’t know where to turn.
Sometimes this results in yet another pregnancy, with no commitment
from the father. These are the women prone to abortion and suicide,
desperate for a way out.
B. Goals and Objectives
It is our goal to bring healing and hope to these women, offering
lifetime change through learning a higher set of morals that will
protect them from more bad choices. We assist financially on a short
term basis. We help to find job training and assist in employment
search. We can even offer adoptive services if they can not raise
their child.
It is our goal to bring healing and hope to women and their
children who are abandoned by husbands and family. We want them to
realize stability through:

50
1.) spiritual guidance that brings lifetime change that will last
2.) learning a higher set of morals that will protect them from more
bad choices.
3.) assistance financially on a short term basis
4.) help in finding job through skills training and assistance in
employment search. We can even offer adoptive services if they
can not raise their child. All clients submit to a complete
treatment plan that leads to life changes and a desire to work,
culminating in graduation.
C. ASSESSMENT / EVALUATION
Gather basic personal information [ w/ interview ]
# Personal History [ Case Work by Social Worker ]
# Medical History
# Referral’s Information [ Basic Information ]
SKILLS INVENTORY / SKILLS TRAINING / JOB PLACEMENT
Assess Skills
Skills Training
# Networking for Possible Job Training
# Job Placement / Assistance to Start Livelihood
HOUSING / BASIC NEEDS
Evaluation of Housing Other Basic Needs
Plan for Financial Freedom / Stability Independence
Sign Contract of Agreement - Ceremony
Close Monitoring Supervision of Money Management
Mentoring Counseling in Financial, Health Sanitation
DISCIPLESHIP / STABILTIY SUSTAINABILITY PROGRAM

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Spiritual Training [ Bible Study Church Involvement ]
Counseling Sessions [Scheduled Regular Meetings ]
Set Goals Objectives—Periodic Assessment
MONITORING / GRADUATION
Continuous Counseling Monitoring of Client
Complete final evaluation Graduation!
[See Appendix for pertinent forms]
7. Training on Sustainable Natural Farming Methods
Using the book written by Mr. Keith Mikkelson as the primary
tool, the agency conducts training on Sustainable Agriculture using
natural farming systems and other technologies appropriate to the
tropical Philippines. The training aims to transfer the technologies
applied by Aloha House on its farms to interested participants, other
agencies who want to grow their own food free of harmful chemicals –
foods which are nutrient dense. It also will help the
gardener/farmer/hobbyist and entrepreneur answer the problem of
food security without harming the environment.
A. History Background
Insert new statistics here on Poverty index for Palawan
The infant mortality rate is currently 16.82.
31% of all households have newborns with weight below 2.5 kilos.
29% are not immunized.
35% do not have access to potable water. (250 kilometers or 10 minute
walk)
34% have no sanitary toilet. 43% have no preschool.

52
37% are not in high school. 9.2% of the road network is paved.
Only 49,000 out of 123,000 homes have power.
Agricultural inputs continue to rise in cost, preventing poor
families from successful food production. Also, Waste
Management in the city is costly, not even considering the
adverse impact it has on the environment. At present, we have a
city landfill that is already producing toxic by-products. We can
reduce significantly the volume of waste put in this landfill.
According to statistics, biodegradable waste put in landfills are
50% of the waste thrown in. The cost of hauling, trucking and
handling will truly be cut down if biodegradable waste will be
segregated at source, processed and utilized to promote farming
and livelihood projects. We will use this resource for farm
fertility along with agricultural waste.
In this farming method, we do not use the expensive and
damaging chemical based fertilizers, insecticides and fungicides.
Using a Japanese technology, we are able to raise hogs, goats
chickens and grow produce organically in the most natural and
environmentally friendly method. Composting is a key for
successful implementation of this technology.
We are able to produce compost and are able to help many
rice farmers and vegetable growers whose main concern now is
the high cost of chemical and fertilizer inputs which are also
rendering their farm lands acidic, hence less productive.
Further- more, farmers are able to make their own farm
fertilizers. Produce is profitable and our integrated livestock
scheme is also an income earner.

53
B. AREA COVERAGE AND BENEFICIARIES
Target area: Province of Palawan
Target group of beneficiaries: Rural and Urban Poor
C. Location of Proposed Project
Aloha House is located in Sta. Monica, Puerto Princesa.
This is where the Demo Farm is located and where the seminars
and training are conducted. It is proven to be effective when
farmers see for themselves how the method is applied. A clean
and no foul smell pig barn with happy healthy hogs is the best
testimony of how the technology successfully works.
A new area is being developed in Barangay Macarascas. In
this area, more appropriate technologies will be showcased like
alternative cooking units, water harvesting and rammed earth
housing models.
D. The Beneficiaries
We intervene with a comprehensive training for families
desiring to work for change through agriculture. We have an
existing training center that has seen over 2,000 participants
over the years. This number includes college students from an
Agricultural Schools, high school students from the Science
High School in the city, other NGOs which thrust is
environmental and livelihood training also benefited from the
training. Individual farmers and hobbyist, agribusiness people
from different parts of the country as well as Trainers from the
Department of Agrarian Reform (DAR) and Agricultural Training
Institute have participated in the training conducted. The
Brooke’s Point local council had a whole day hands on training on

54
waste management and composting biodegradable kitchen waste.
Lately, NGOs from Luzon and from Kota Kinabalu, Malaysia, sent
their team members for training and internship. Many
participated in the Internship Program of 4-months. They are
Participants from all over – the Philippines, Liberia, Singapore,
Malaysia, USA and Nepal.
E. The Long Term Goal and Direction of the Project
Currently, we are expanding the training center to prepare
students more intensively for their own natural farm and piggery
through our internship training program sweat equity payback
scheme to proven graduates.
We will also use restaurant waste and manure for fertilizer
and value added products. The meat can be readily sold in the
city as organic for a premium price. Our pilot project has already
developed the market! This will empower each farmer to succeed
by continual monitoring at our campus, then upon successful
technology transfer we pay back their sweat equity with start up
supplies and livestock. Eventually our natural foods will be sold to
Japan as an export premium. Current local demand is adequate to
build up growers.
F. Goals and Objectives
Goals: Empower the indigent community through
internships on an existing natural farm, creating independent,
self sufficient food producers to strengthen their families, thus
the Province and the Nation.
Objectives:

Train farmers on resource recovery, turning waste into
wonderful inexpensive fertilizers and composts
Produce products for market and family consumption, utilizing
fertilizers to grow premium vegetables for sale
Utilize our proven NPPS [Natural Pig Production System], goat
and free range chicken with graduates who have mastered the
methods
Create a cottage industry of organic fertilizers from Vermi-composting
55
of manure and restaurant food waste
We will pre-qualify interns and train them in a 4 month
course in sustainable agriculture. They will master the
techniques necessary for success, including fertility and seed
production, product handling and marketing, record keeping and
planning.
We are currently collecting kitchen waste from a
restaurant and will expand as interns and staff is trained. It is
processed with Effective Micro-organisms along with manure and
sawdust for worm feed to make quality fertilizer.
G. Implementation:
Our field social worker will help qualify and select from our
almost 1,000 Natural Farming seminar attendees and partner
agencies referrals. We will target in the first year 6 candidates
for internship. We will have a 3 day pre-selection training to
screen for the best and most eager trainees. We take on 2 new
participants per month [overlapping], each undergoing a 6-month
program. Hard work and efficient technique will be emphasized.
Newer students help graduates install composting barn, piggery
and garden and return to finish course. Graduates are evaluated
by our social worker to determine capabilities. Sweat equity is

56
repaid in start up supplies, seeds and livestock. On going support
and consultation as well as marketing is included.
The technology is transferable, uncomplicated. We have
data available and have documented the process in print and
video. This is our mission and vision, to help poor families, and
we believe that through this we will be able to do it. We do not
believe in dole out, rather, we believe that if we teach the
people how to plant, they will reap the harvest.

VII. Organizational Structure
A. Governing Board
58
Aloha House board of trustees / directors are all active members of
the community in Palawan.
1. Board of Directors
a) Keith Mikkelson USA President
b) Narcy Mikkelson Philippines V.P./Secretary
c) Johnny Montealegre Philippines Treasurer
d) Juliet Montealegre Philippines Trustee
e) Chun, Hee Kyung Korea Trustee
2. Duties of the Board
The Board is the policy making body. They have over all
responsibility and supervision of the corporation. They see to it
that the agency is on tract to achieve its goals and objectives.
The board also reviews and discusses financial reports and
complies with all laws of the Philippine government.

Personal and Staff
59
3. Structure
B. Organizational Structure

60
C. Communications Flow Chart

Personal and Staff
61
VIII. Personnel and Staff
A. Positions
! Executive Director
! Assistant Director
! Admin Staff
! Social Worker
! Livelihood Assistant
! Teacher
! Nursery Supervisor
! Caregivers
! Cook
! Assistant Cook
! Housekeeping Supervisor
! Housekeeping Assistant
! Farm Supervisor
! Farm Staff and Workers
*Service Coordinator (A duty done by the assistant director in
coordination with the Cook and Admin Assitant), To be Hired When
Needed to work full-time)
B. Job Descriptions
1. Executive Director
! Responsible for the supervision, management and
implementation of projects and activities of Aloha House.
! Evaluates the outcome of programs with staff.
! Determines the needs based on evaluation made and then
recommends a plan of action.
! Coordinates and initiates linkage with other established social
agencies for networking.
! Prepares monthly and quarterly accomplishment reports.
! Reports to the Board and DSWD.

62
! Performs other such functions that the Board may direct.
2. Assistant Director
! Assists the Director in the supervision, management and
implementation of projects and activities of Aloha House;
! Acts for and in behalf of the Director in his absence or as
directed and sanctioned to represent the Director;
! Assist in the valuation of the outcome of programs with the
staff;
! Assists in determining the needs based on evaluation made;
! Assists the director in coordinating and initiating linkages
with other established social agencies for networking.
! Reviews monthly and quarterly accomplishment reports
before submitting to the director;
! Performs other such functions that the Director may asked;
! Acts as the Personnel Manager
3. Admin Staff
! Assist the Personnel Manager in the maters of personnel
management and monitoring;
! In-charge of the details of marketing and customer relation;
! In-charge of the bookkeeping;
! Works directly with the cashier and coordinates purchase
orders and other matters concerning administrative
functions;
! Manage office staff.

Personal and Staff
63
4. Social Worker
! Identifies the needs of the children and provides appropriate
social services.
! Responsible in keeping the confidential records of each child
and track their progress.
! Provides counseling for each child ‘s needs, desires and
problems.
! Coordinates with the community for resources in
administering social services.
! Performs other duties in helping the children and staff and
household management.
! Receives cash and issues receipts;
5. Service Coordinator (*)
! Prepares budget for purchases of daily needs.
! Plans meals and oversees kitchen staff.
! Supervises and coordinates income generating projects.
! Supervises and coordinates donated professional services
such as doctor and dental work.
! Oversees garden staff and transportation.
! Perform such other functions as deemed necessary.
6. Livelihood Assistant
! Participate in all the livelihood projects of the agency;
! Keeps tab of the livelihood projects stocks/inventory
including packaging materials;
! Coordinates with the concerned staff anything and everything
about the processing and production of livelihood products;
! Receives cash and issues receipts when Admin. Assistant is
out of the office;

64
7. Teacher
! Responsible for implementing and teaching the school
curriculum for any student under the homeschool program;
! Keeps and maintains the file of the student/school records;
! Submits them to the authority;
! Monitors the student/students performance and evaluation
results;
! Coordinates with other teachers when called for;
8. Nursery Supervisor
! Responsible for the management and supervision of nursery
clients and Nursery staff and its physical facility.
! Attends to the needs of the children and advises all
concerned staff for the appropriate action.
! Engages children in weekend recreational activities such as
swimming, going to parks, special events.
! Looks after those attending school and makes sure needs are
met for upcoming classes.
9. Caregivers
! Watches over infants and babies as a mother would her own
children.
! Helps in daily duties of the nursery.

Personal and Staff
65
10. Cook
! Watches over kitchen and keeps it safe;
! Cook nutritious meals on time and clean up afterwards;
! Executes the planned menu;
! Submits market and grocery list;
! Keeps freezer and pantry inventory and request purchase
when needed;
! Performs such other functions as deemed necessary;
11. Assistant Cook
! Assists the cook with all kitchen duties and responsibilities;
! Helps prepare nutritious meals on time and clean up
afterwards;
! Assists the cooks in executing the planned menu;
! Helps submit market and grocery list;
! Helps in Keeping the freezer and pantry inventory and
request purchase when needed;
12. Housekeeping Supervisor
! Receives and keeps inventory of all household supplies and
place them in the stock room ;
! Oversees the cleaning, tidying and making of beds in the
guests rooms, and other specified rooms;
! Reports any maintenance needs for any guest room and the
whole facility if the need arise;
! Oversees the cleaning and keeping of the facility and its
surroundings spic and span;
! Waters the ornamental plants of the facility;
! Maintains the cleanliness of the facility and its surroundings

66
13. Housekeeping Assistant
! Performs functions assigned by the Housekeeping Supervisor
! Assists in maintaining the cleanliness of the facility and its
surroundings;
! Performs the duties and responsibilities specified by the
Housekeeping Supervisor;
14. Farm Supervisor
! Executes the duties and responsibilities outlined by the
Director to keep the farm and its livestock running and
healthy;
! Assist in training farm new hires and interns to be able to
understand the sustainable farming method applied at Aloha
Farms;
! Directly Oversees the other farm workers and staff as well
as interns;
! Reports any incidences concerning livestock and plants and/or
farm operation in general;
! Request purchase of farm implements, supplies and needs
when deemed necessary;
15. Farm Staff and Workers
! Execute the duties and responsibilities assigned in the
different Farm sections for daily tasks and other specific
tasks assigned for the week or day;

Personal and Staff
! Make sure Farm Protocols are followed to ensure that
principles of sustainable and environment friendly practices
are implemented;
! Takes good care of plants and animals and reports any
problems immediately concerning both;
67
C. Qualification Standards
! Physically fit and morally upright.
! Must be willing to serve to their fullest ability.
! Prior to hiring an interview is taken with applicant and
requirements are submitted and are in order;
! A Christian commitment is necessary to fully serve in this
ministry.
D. Community Resources
We are thankful for the growing community support. The following
professionals recognize the needs of the children in this area. They have
agreed to volunteer services free of charge to this organization and / or
our clientele.
Pediatrician: Dr. Leo Valderama
OB / GYN Dr. Lorna Boglosa-Felizarte
Dentists: Dr. Fatima Ong / Dr. Joan Ababa
Lawyer: Atty. Julius Concepcion
Accountant: Annabelle Pastrana-Ong,CPA

IX. Budget
A. Sources of Funding
68
1. Sure Foundation International, Texas, USA
2. Vail Bible Church, Colorado, USA
3. Hope Chapel, USA
4. Trinity Baptist Church, USA
5. Private Individuals
B. Financial Forecast – Five Year Forecasted Budget
The 5 year Financial Forecast is based on the following assumptions:
! Capable of taking in children to full capacity of 22
! Increase in caregivers and staff as needed
! 5% inflation rate
! 10% Increase in needs based on expansion and additional clients
! Building projects and property is not included in this forecast and
listed separately below
Projected Administration and Operating Expenses
2015 2016 2017 2018 2019 2020
Project Expense:
Orphanage
Social Workers and
Caregivers Expense
611,710 703,466 808,986 930,334 1,069,885 1,230,367
Food Expenses and
Supplies
1,073,217 1,234,200 1,419,330 1,632,230 1,877,064 2,158,637
Nursery Materials
and Supplies
152,448 175,315 201,613 231,855 266,633 306,628
Household Supplies
and Materials
190,259 218,798 251,618 289,360 332,764 382,679
School Supplies
Expense
14,071 16,182 18,609 21,400 24,610 28,302

Supervision, Monitoring and Evaluation
69
Medical and Health
Expense
26,755 30,769 35,384 40,692 46,796 53,815
Project : Outreach
Garden
Outreach Ministry
and Livelihood
19,728 22,687 26,090 30,004 34,504 39,680
Garden Expense 1,883,739 2,166,300 2,491,245 2,864,932 3,294,672 3,788,872
Training Seminars 50,361 57,916 66,603 76,594 88,083 101,295
Livelihood Expense 314,873 362,104 416,420 478,883 550,715 633,322
Special Projects 1,628,653 1,872,950 2,153,893 2,476,977 2,848,524 3,275,802
Administration
Expenses:
Office Admin.
371,116 426,783 490,801 564,421 649,085 746,447
Expense
Staff Workers
Wages
404,714 465,422 535,235 615,520 707,848 814,026
Benefit Expenses 441,556 507,789 583,958 671,551 772,284 888,127
Fuel, Water and
Power Expenses
1,003,784 1,154,352 1,327,504 1,526,630 1,755,625 2,018,968
Repairs
Maintenance
386,745 444,756 511,470 588,190 676,419 777,882
Communications
Expense
85,982 98,879 113,711 130,767 150,383 172,940
Transportation
Expense
201,057 231,216 265,899 305,784 351,651 404,399
Representation
Expense
5,114 5,881 6,763 7,778 8,944 10,286
Taxes Licenses
Expense
5,248 6,035 6,941 7,982 9,179 10,556
Depreciation
Expenses
432,732 479,642 572,288 658,131 756,851 870,379
Professional Fees 6,900 7,935 9,125 10,494 12,068 13,878
Miscellaneous
Expense
80,089 92,102 105,918 121,806 140,076 161,088
Total Expenses 6,336,930 7,287,470 8,380,592 9,637,682 11,083,335 12,745,846
D. 10 year Work Plan
2014-This year we plan to increase training for families and improve the
children’s facility. The new properties will facilitate our sustainable
agriculture for families and help meet these needs. This will allow interns to
learn to produce high quality marketable food products profitably. We also
need to replace our old truck with reliable transport.

School Room, Training center, Goat House, Barns $80,000
Vehicle $21,000
2015- We will continue to develop properties for agricultural program and
school buildings (see page 47). Continue to develop Mothers With Hope
Program (see page 49). Increase Agricultural Internships utilizing
completed dorms (see page 51).
School Center $100,000
Fencing, gates and roads $7,000
Deep-well and pump-house $12,000
Transport Van $30,000
Fencing, gates and roads $7,000
2016- Develop educational programs for older children.
Start replicating the most needed services in northern regions of the
island.
2017- Oversee growth of expansion areas and monitor effectiveness.
2018- Expand services north.
2019-22- Strengthen funding and support for on-going operations.
70

Supervision, Monitoring and Evaluation
71
X. Supervision, Monitoring and Evaluation
A. Supervision
1. The Executive Director oversees the whole operation;
2. The Head Caregiver the Social Worker supervise the
activities of the children and monitor their progress and
development;
3. The Executive director assigns Farm supervisors as deemed
necessary to oversee either each section of the farm or each
specific operation or project;
4. Supervision is 24 hours for the children;
5. Special Projects will have specific person/persons assigned;
B. Monitoring
1. Meetings of the Board of Directors where the Executive
Director reports on the operational and financial status.
2. Regular staff meetings with feed back and appropriate
actions are tackled;
3. Regular staff meetings to share problems and explore
solutions as a team;
4. Specialized monitoring tools such as intake forms, child
health records and case files and evaluation forms for the
Farm Interns and;
5. Yearly staff and workers performance evaluation done by the
personnel manager and the direct supervisor;
6. Projects and programs are also evaluated during strategic
planning sessions;

C. Evaluation
72
Evaluation found in the following:
1. Annual report
2. Progress reports
3. Financial reports
4. Incident reports
5. Accomplishment reports
6. Evaluation Tools used for the interns

Reporting and Recording System
73
XI. Reporting and Recording System
Proper recording and reporting is very important to the growth of the
organization and the children. With accurate records and information
the staff will better be able to serve the community.
2 year Work and
Financial Report
President
[signatures ]
DSWD Region 4
Social
Worker
NGO Treasurer
Outside
Accountant
Select Annual Reportal Requirements
B.I.R. S.E.C.
Due. Jan. 31
1 604 -C
1 604 -CF
7.1
7.2
7.3
7.4
Due April 15
Income Statement
Balance Sheet
Income Tax Return
1702
170 2-AIF
1601
2316
Lists may be incomplete, requirements change often
Community Tax
Social
Worker
[forms]
President
[signatures ]
DSWD
Accomplishment
Report
Financial Report
Mayor’s Permit
Medical Exams
CITY HALL
1. Community Tax
2. Barangay Clearance
3. SEC Articles (Xerox)
4. Busines s Tax
5. Land Tax Clearance
6. Zoning Clearance
7. Fire Certificate
8. PhilHealth Cert.
9. SSS Cert.
10. Sanitary Health
11. Previous Mayor’s
Permit
12. ACR/ICR (For
Aliens)
General Info Sheet
Minutes Annual
Meeting
Stamped BIR
Income
Balance Sheet
1702
1 702 -AIF
Due 15 days after
Annual Meeting
• Annual Narrative
Accomplishment Report
• Case Summary
• Clients Served
Quarterly
Reports
[Clients Served]
No guarantee of accurate or complete information
is implied. Listing is compiled on multiple go v-ernment
and NGO sources that may or may not be
accurate. It is your responsibility to s tay current
with requirements for your NGO.
Compiled by Keith Mikkelson (048 434 6011)
Aloha House Inc., ABSNET Member.

74
A. Records and Files
The following will be kept and monitored:
! Formal education of children while in our care
Diagnostic Tests
Major Tests
UNIT Tests and PACE Tests Accomplished
Yearly Progress Report
Attendance Records
Activity Sheets of the Children
! Non-formal education
Training Files Records
Skills Acquired Attendance Certificate
! Staff meetings
Minutes of Meetings
! Staff records
Basic Employment File
Resume Bio Data
Medical Records
Vacation Sick Leave File
BIR/SSS/PhilHealth File

75
! Special activities
Documented by Photos or Videos
! Celebrations
Documented by Photos or Video
! Family picnics
Documented by Photos or Videos
! Holidays
Calendar of Activities for the Month File
! Birthday parties
Photographs Video File
! Field trips
Calendar of Activities, Photos Video
! Community outreaches
Survey File
Program File
Accounting File
Photos Video

B. Medical
76
Medical Record for each Child / Client
Record of Medicines Given
Feeding Record (for infants)
Immunization Record
C. Counseling and Meetings
Case Conference File
Voice Tape Record File
Referral File
D. Financial
Disbursement
a. Record of Amount Disbursed
b. Liquidation
Bookkeeping
a. Vouchers made on payments and expenses
b. Recording in Account Books
Accounting / Auditing
a. Summary of Expense
b. Financial Statements
c. Audit Certificate by Independent Accountant

77
Housekeeping
Nursery
Kitchen
Office
Farm
Feedback
Request for
Procurement
Purchasing
Stocking
End Users
Inventory of
Stocks
Aloha House Inc
Property and Supplies Management Flow Chart

78
Budget Officer
Review/Check
Financial
Statement
Cashier
Disbursement
Liquidation
Voucher
Petty Cash
Posting
Summery of
Expenses
Auditing
Bills
Salaries
Donations
Income
Disbursement
Check Issuance
Voucher
Posting
Summery of
Expenses
Aloha House Inc
Cash Disbursement and Bookkeeping Flow Chart

Annexes
79
XII. Annexes
Employee and Volunteers Manual
DSWD Endorsement
Organizational Chart
Foster Parent License
Agency Forms

Employee and Volunteers Manual
General Rules:
80
All staff/volunteer and Interns are required to obey posted rules and
regulations. Cleanliness, orderliness and harmonious relationships are
important aspects of the home and community living as well as the general
working environment.
A Time Clock/Punch Card is provided for uniform time-in and time-out.
Different departments have different work schedules, but everybody has
a minimum 8-hour work day for 6 days a week. A fifteen-minute break in
the morning and another 15-minute break in the afternoon are provided for
snacks time as well as one (1) hour lunch break from 12:00 noon to 1:00 P.M.
Each Caregiver directly working with the children must wash hands
before handling babies. Employees are required to wear the uniforms
provided for them. Be sure to read all memos and new rules before each
work shift.
A. Volunteers
Volunteer workers have no employee/employer relationship with
Aloha House. Usually the person is able to come and go as they desire.
• Foreign volunteers workers should pay their own travel
expenses, board lodging and should have pocket money.
Aloha House will serve as a training ground for the
volunteers to prepare them for future ministry in line with
childcare, community development work and agricultural
training.

Annexes
• All volunteers staying inside the campus should shoulder
their food and lodging unless the volunteer and
management agree upon a special arrangement, wherein
these fees are waived or set fees are reduced. Volunteers
are required to file an application and submit necessary
documents needed before they are approved to volunteer
at Aloha House.
Aloha House Inc. is well staffed. Hence, volunteers are accepted more
for their own gain. For the volunteers, working at this institution is an
opportunity for work experience and exposure to social welfare and
agriculture related fields. Funds are allocated to cover for the
expenses, such transportation and other incidental expenses incurred
to fulfilling responsibilities related to his/her duties at
Aloha House.
Volunteers are given specific work hours, duties and
responsibilities depending on where help is needed and the volunteer’s
skills and interests.
Our full-time volunteers may receive one, two or all of the
following if the institution so desires in case of much needed help and
expertise and where a volunteer is willing to render his/her services
for free:
! A small love gift;
! Travel allowance;
! Additional help for their family, on a case to case basis,
which is determined and stipulated in the agreement and
conditions upon which the volunteer was accepted.
81

82
B. Interns
C. Regular Staff
! All wages are to be reported to the S.S.S. and the B.I.R.
! PhilHealth and PAG-IBIG contributions are mandatory
! An employee must understand Rules and Guidelines and be
willing to abide by said rules by affixing his/her signature on
the Employees Manual.
! The staff will serve as good, moral and loving role models for
all the children in their care as well as the community. They
must display respect, honesty, diligence and fear of God.
!
D. Work Days, Day Off and absences and Leave Privileges
! Regular scheduling will be set by Director and/or Supervisor
! Hours served as volunteer are not counted toward regular
hours
! Some duties may allow for split shifts
! One day off a week is set unless a need/emergency arise
which needs for an employee to report and re-set his/her
day-off.
! An employee is required to inform his/her immediate
supervisor if not the Personnel Manager, by phone or text, if
he/she cannot report to work for the day but has not filed a
Leave of Absence/Sick Leave or Vacation Leave. Otherwise,
failure to do so means Absence without Leave (AWOL), which
is considered violation.
! Vacation leave is offered after one year of employment. An
employee is entitled 5 working days vacation as a Service
Incentive. Emergency leave can also be availed and can be

Annexes
charged against the service incentive. When due leave
however is used up any leave after that even if it is an
emergency leave is no longer with pay as long as necessary
paper work is fulfilled and duly approved.
! Leave is also available without pay for personal reasons
! Maternity Leave may be available through S.S.S. According
to law: SSS maternity benefit shall be equivalent to 100% of the
pregnant employee’s average daily salary credit for 60 days, or
78 days in case of caesarian delivery. Aloha House will
advance the amount equivalent to this SSS maternity benefit
provided all necessary documents, requirements needed to
avail such have been fulfilled and filed, so the company will be
timely reimbursed by SSS without delay.
! Medications can be reimbursed by PhilHealth provided all
documents required under its provisions are met.
! Service Incentives not used up can be commuted to cash
83
! Other Staff Workers’ Privileges
Outings are set by the institution for staff bonding and
relaxation once every two months. This includes, swimming
activities, eating out and sightseeing of places they have
not been to. This privilege is not convertible to cash.
$ Regular Staff and Workers receive 13th month pay
Christmas gifts.
$ Caregivers can also travel outside the province if there is a
necessity to accompany a child for medical examination.
$ Farm Staff and those involved in the Livelihood Projects can
enjoy the Profit Sharing Incentive of which is determined by
the Management based on the employees contribution to
profitability, loyalty and performance.
$ This institution has GREEN policies and GOOD
STEWARDSHIP standards. Training has been done to be able
to engage in such practices and develop a culture of savings

84
instead of squander and being creative instead of being
destructive. In line with this, monitoring system is in place
and evaluation in included. Employees are rewarded with
incentive and/or corresponding increase for adhering to this
G. Training and Development
! Ongoing training will be available to all regular staff on a
regular basis
! Programs from the DSWD can be utilized
! Training will be offered for technical, social and spiritual
development as well as child care service
H. Dismissal, Termination and Disciplinary Actions
Staff will be dismissed for:
! Crime
! Concealment Dishonesty
! Fraud
! Gambling
! Neglect of duties
! Immorality
! Insubordination
! Misconduct
! Smoking
! Drug use
! Alcohol Abuse
! Child Abuse
! AWOL
• Violation of any rules may result in immediate termination
without any privileges and incentives to be availed.
• A clear explanation must be given to worker for termination.

Annexes
• Verbal warnings and written warnings can be used as well as
suspension.
• Written warnings will be signed and filed by employee. Upon 3
warnings in any 12 month period an employee will be dismissed
for their inability or situations which can cause dismissal.
85
I. Home facility Policies-Staff involvement
1. Aloha House has provided the children’s home with a clean,
sanitary and safe environment well suited for a child’s
upbringing. The staff will actively maintain the safety and
cleanliness of the home at all times.
2. Aloha House has complied with all the requirements listed
below and in accordance with all the existing laws and
ordinances of the government:
! Careful selection of staff
! Fire safety compliance
! Health laws
! Home maintenance
! Labor laws
! Water filtration
The staff will comply with all regulations relative to these
laws.

Forms
87
GENERAL ADMISSION FORM
Date: _______________________
To Whom It May Concern:
This is to certify that Aloha House has received,
Name of the child: ____________________________________________________
Age: _____________________ Sex: _______________________
Birthday: ____________________________________________________
Birthplace: ____________________________________________________
Address: ____________________________________________________
Health/ Physical Condition:
____________________________________________________________________________________
____________________________________________________________________________________
Category/ Agreement:
__________________________________________________________________________________________
__________________________________________________________________________________________
_______________________________________________________________________
Referred by:
_____________________________________ _____________________________________

Forms
88
Signature over printed name Signature over printed name
_____________________________ _____________________________
Relation to the Child Relation to the Child
_____________________________________ _____________________________________
Address Address
Received by:
___________________________ _________________________
Director Social worker
WITNESS
_______________________________________ _______________________________________
Signature over printed name Signature over printed name
_______________________________________ _______________________________________
Address
Address

Forms
89
CHILD INTAKE FORM
Case No. __________ Date: ________________________
Category: ____________________________________
Identifying Information:
Name : ________________________________________________ Sex: ___________ Age: ______________
Birth date: _________________________ Birthplace: _____________________________________________
Address: __________________________________________________________________________________
Religion of the family: ____________________________________ Contact # of mother: _________________
Source of Referral: ____________________ Nickname: __________________ Contact #: _________________
Address: __________________________________________________________________________________
Family Composition:
Name Age/Bday Sex Rel. to Child Ed. Attainment Occupation Income
_________________ ___________ ______ ___________ ______________ ______________ __________
_________________ ___________ ______ ___________ ______________ ______________ __________
_________________ ___________ ______ ___________ ______________ ______________ __________
_________________ ___________ ______ ___________ ______________ ______________ __________
_________________ ___________ ______ ___________ ______________ ______________ __________
_________________ ___________ ______ ___________ ______________ ______________ __________
_________________ ___________ ______ ___________ ______________ ______________ __________
Reasons for Coming to the Institution:
__________________________________________________________________________________________
__________________________________________________________________________________________

Forms
__________________________________________________________________________________________
__________________________________________________________________________________________
Medical History, Present Health Condition and Functioning of the Child:
Pre-natal care of the mother: __________________________________________________________________
Abortion attemps:___________________________________________________________________________
Immunization: _____________________________________________________________________________
Diet: _____________________________________________________________________________________
Previous illness: ____________________________________________________________________________
Present illness: _____________________________________________________________________________
Hospitalization date cause: _________________________________________________________________
Speech:___________________________________________________________________________________
Functioning: _______________________________________________________________________________
Medical History of Other Family Members:
Family’s diet: ______________________________________________________________________________
Mother’s previous illnesses: __________________________________________________________________
Present illness: _____________________________________________________________________________
Illness while pregnant of the child: _____________________________________________________________
Father’s previous illnesses: ___________________________________________________________________
Present illness: _____________________________________________________________________________
Child’s sibling/s’ previous illness: ______________________________________________________________
Sibling/s’ present illness; _____________________________________________________________________
Family member who is already dead: ___________________________________________________________
Cause of death: ____________________________________________________________________________
FAMILY BACKGROUND INFORMATION:
Date place of marriage: ____________________________________________________________________
90

Forms
91
Marital relationship/ decision-making: __________________________________________________________
_________________________________________________________________________________________
Housing condition : _________________________________________________________________________
_________________________________________________________________________________________
A) Mother of the Child : ____________________________________________________________________
Birthday Birth place: ______________________________________________________________________
Dialect/s: _________________________________________________________________________________
Work experience: __________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Previous relationships: ______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Name of Parents Occupation Address
__________________________ ___________________________ ________________________________
__________________________ ___________________________ ________________________________
Names of siblings Age/Civil status Occupation Address
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
B) Father of the Child: ____________________________________________________________________

Forms
Birthday Birth place: ______________________________________________________________________
Dialect/s: _________________________________________________________________________________
Work experience: __________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Previous relationships: ______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
92
__________________________ ___________________________ ________________________________
__________________________ ___________________________ ________________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
_________________________ ________________ ___________________ __________________________
OTHER FINDINGS:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Source/s of Information: _____________________________
_____________________________ Taken by: ______________________

Forms
PARENT INTAKE FORM
Case No. __________ Date: ________________________
Category: ____________________________________
Identifying Information:
Name : ________________________________________________ Sex: ___________ Age: ______________
Birth date: _________________________ Birthplace: _______________________________
Address: __________________________________________________________________________________
Educational Attainment: _____________________________ Occupation: _______________________
Religion : _________________________________________________________________________________
Dialects: __________________________________________________________________________________
Source of Referral: __________________________________________________________________________
Address:
__________________________________________________________________________
Family Composition:
94
Name Age/Bday Sex Rel. to Child Ed. Attainment Occupation Income
_________________ ___________ ______ ___________ ______________ ______________
_________________ ___________ ______ ___________ ______________ ______________
_________________ ___________ ______ ___________ ______________ ______________
_________________ ___________ ______ ___________ ______________ ______________
_________________ ___________ ______ ___________ ______________ ______________
_________________ ___________ ______ ___________ ______________ ______________

Forms
Reasons for Coming to the Institution:
__________________________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________________________
______________________________________________________________________________
95
Background of the Problem:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________________________________
____________________________________________________________________________________
Economic Condition: (Other source of income, monthly income, work experience interest, housing Condition)
_________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
________________________________________________
Medical History and Present Health Condition:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________________________________
Present Medical Condition History of Other Members of the Family:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
________________________________________________Family Background Information:
Date Place of Marriage: ____________________________________________________________________
Marital Relationship/ Decision-making
__________________________________________________________________________________________
________________________________________________________

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Previous relationships:__________________________________________________________________
______________________________________________________________________________________________________________
______________________
96
__________________________ ___________________________ ___________________________
_________________________ ________________ ___________________ _____________________
_________________________ ________________ ___________________ _____________________
_________________________ ________________ ___________________ _____________________
Source/s of Information: _____________________________ ______________________________
_____________________________ ______________________________
Taken by: ________________

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97
BIRTH CERTIFICATE DRAFT :
Name of Child : ________________________________________________________________________
First Middle Last
Sex : _______________________________________ Date of Birth : ______________________________
Place of Birth : _______________________________ Type of Birth : _____________________________
Time : _______________ Weight at Birth : ________________ Birth Order of the Child :______________
Maiden Name of Mother :_________________________________________________________________
First Middle Last
Age at Birth of Child : _________________________ Occupation : _______________________________
Citizenship : _________________________________ Religion : _________________________________
Present Address : _______________________________________________________________________
First Middle Last
Age at Birth of Child: _________________________ Occupation : _______________________________
Citizenship : _________________________________ Religion : _________________________________
Place of Marriage of Parents : _____________________________________________________________
Date of Marriage of Parents : ______________________________________________________________
Total No. of Children Born Alive: _______ Total No. of Children Born Alive But are Now Dead: _______

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Attendant at Birth : ____________________________ Position : _________________________________
Address : ______________________________________________________________________________
Informant : ____________________________________________________________________________
Relation to Child : _______________________________________________________________________
Address : ______________________________________________________________________________
Requirements for Delayed Registration :
98
1. Baptismal Certificate or Certificate of Barangay Captain:_____________________________
2. Community Tax Certificate No. _________________________________________________
Date Issued : _____________________________________________________
Place Issued :_____________________________________________________
3. Signature of Hilot: ___________________________________________________________
Informant : ______________________________________________________
Affiant : ________________________________________________________
4. Publication/ Posting for 10 days : _______________________________________________
5. Payment ; Paid OR No. ___________________ Unpaid : __________________________
Amount : _______________________________________________________

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99
Date of Payment : ________________________________________________

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PANAWAGAN 1
100
December 26-28, 2001
Tinatawagan ang pansin nina Mr. And Mrs.__________________ na kung maaari ay
makipag-ugnayan sa social worker ng Aloha House Orphanage na matatagpuan sa Libis,
San Pedro, Puerto Princesa City o tumawag sa numerong ito: 433-5367. Ito po ay may
kinalaman sa inyong anak na si ___________ na isinilang noong June 20, 2001 sa
Provincial Hospital, Puerto Princesa City na nasa kasalukuyang pangangalaga ng naturang
ahensiya.
Kung sino man po ang nakakakilala sa mga magulang ng nasabing bata ay maaari lamang
pong ipagbigay alam ang panawagang ito.
Maraming salamat po.
Nananawagan,
________________________________
Social Worker, Aloha House Orphanage
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
This is to certify that minor, _________ has been aired over the Radio Program indicated below.
This certification is issued upon the request of Aloha House
Orphanage and DSWD Regional Office IV for the purpose of filing the
petition for Abandonment of said minor.
RADIO STATION: RGMA-DYSP Super Radyo

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101
DATE TIME PROGRAM ANNOUNCER
(Printed name signature)
____________ _________ _________________ ____________________________
____________ _________ _________________ ____________________________
____________ _________ _________________ ____________________________
____________ _________ _________________ ____________________________

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PANAWAGAN 2
102
October 10-12, 2003
Tinatawagan ang pansin nina _____________________________ ng Roxas St. Puerto
Princesa City, na kung maari ay makipag-ugnayan agad sa ALOHA HOUSE na
matatagpuan sa Libis, San Pedro, Puerto Princesa City o tumawag sa numero: 433-5367 o
cellfone # 09169331878 bago lumipas ang ika-15 ng Oktubre taong 2003 sa dahilang
mayroon kayong mahalagang pag-uusapan.
Kung sino man po ang nakakakilala sa mga nabanggit ay maaari lamang pong ipagbigay
alam ang panawagang ito.
Maraming salamat po.
Nananawagan,
ANN BILLANO
Aloha House, Inc.

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103
PHYSICAL EXAMIN MEDICAL HISTORY OF CHILD
Child’s Name: __________________________________________ Age: ________________________
Date of Birth: ___________________________________________ Sex: ________________________
Height: _________________ Weight: __________________ Head Circumference: _______________
Color: Skin: _________________ Eyes: ____________________ Hair: ______________________
Physical Assessment:
Vision: ___________________________________ Ears:
_____________________________________
Nose: ____________________________________ Teeth:
____________________________________
Throat: ___________________________________ Heart:
____________________________________
Chest: ____________________________________
Abdomen:_________________________________
Posture: __________________________________ Spine:
___________________________________
Nervous System: ___________________________ Reflexes: _________________________________
Legs: ____________________________________ Feet:
_____________________________________
Skin: ____________________________________ Genitalia: _________________________________
Medical History: (Illness, Treatment/Medicines, Duration of Treatment)
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
____________

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Physician’s general observations of the child’s present mental, health physical condition:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________
Date:
Physician ___________________________________
License # ______________________________
104

Forms
105
CLOSING SUMMARY FORM
Name:__________________________________________ Sex: ___________ Date:
____________________
Date of Birth: ___________________________________ Place of Birth:
______________________________
Date of Admission: _______________________________ Date of Discharge:
___________________________
Age upon admission: ______________ Age upon discharge: ______________ Length of stay:
____________
Source of Referral: ____________________________Address:
________________________________________
Mother: _____________________________________Address:
________________________________________
Occupation: __________________________ Ed. Attainment:
__________________________________
Father: _____________________________________ Address:
________________________________________
Occupation: __________________________ Ed. Attainment: __________________________________
Receiving Party: _____________________________________ Relation to the Child: _____________________________________

Forms
106
Address: _________________________________________________________________________________________________
REASON FOR CLOSING THE CASE:
______________________________________________________________________________
______________________________________________________________________________
CASE MANAGEMENT:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
RECOMMENDATION:
______________________________________________________________________________
______________________________________________________________________________
____________________________________
Social Worker
____________________________________
Director

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107
PHYSICAL EXAMINATION MEDICAL HISTORY OF CHILD
Child’s Name: __________________________________________ Age: ________________________
Date of Birth: ___________________________________________ Sex: ________________________
Vision: ___________________________________ Ears:
_____________________________________
Nose: ____________________________________ Teeth:
____________________________________
Throat: ___________________________________ Heart:
____________________________________
Chest: ____________________________________
Abdomen:_________________________________
Posture: __________________________________ Spine:
___________________________________
Legs: ____________________________________ Feet:
_____________________________________
Skin: ____________________________________ Genitalia: _________________________________
Medical History: (Illness, Treatment/Medicines, Duration of Treatment, Dosage, Reasons for Treatment)
______________________________________________________________
_
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

Forms
______________________________________________________________
______________________________________________________________
______
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
_______________________________________________
Date:
108
Dr. Leo Emilio L. Valderrama, M.D. DPPS
Pediatrician
License # _________________________
VALDERRAMA CHILD HEALTH CLINIC
Palawan Medical City, Inc.,
Malvar Street., Puerto Princesa City
Tel. (048) 434-4849

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109
MEDICAL CERTIFICATE
Child’s Name: ____________________________________ Age: ________________________
Date of Birth: __________________________________________ Sex: _____________
Height: _______________ Weight: ______________ Head Circumference: _______________
Medical History: (Illness, Treatment/Medicines, Duration of Treatment, Dosage, Reasons for Treatment)
______________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
____________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
_____________________________________________
Date:
Dr. , M.D. DPPS
Physician License # ____________________

Forms
PHYSICAL EXAMINATION REPORT
Child’s Name:
Date of Birth:
Color: Skin: Eyes: Hair:
Height: Weight: Head Circumference:
Vision: Hearing:
Nose: Teeth:
Chest:
Posture: Heart:
Spine: Nervous System:
Legs: Reflexes:
Abdomen: Feet:
Any other (any defects)
Any comments:
Physician’s observations of child’s general condition of mental and physical development:
Date:
110

Forms
111
Physician

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CERTIFICATION of Immuniztions
TO WHOM IT MAY CONCERN:
112
This is to certify that Mele Nanie Almoguera, born on February 24, 2004 of Barangay Sta.
Monica, Puerto Princesa City was given the following immunization shots as per record of this clinic.
Type of Vaccine Date Given
DPT 1 --------------------------------------------------- April 13, 2004
Polio 1 -------------------------------------------------- April 13, 2004
Hepatitis B 1 ------------------------------------------ April 13, 2004
DPT 2 --------------------------------------------------- May 19, 2004
Polio 2 -------------------------------------------------- June 23, 2004
Hepatitis B 2 ------------------------------------------- May 19, 2004
DPT 3 --------------------------------------------------- June 23, 2004
Polio 3 -------------------------------------------------- July 21, 2004
Hepatitis B 3 ------------------------------------------- June 23, 2004
This certification is issued upon request of Aloha House Inc. for adoption purposes.

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113
Dr. , M.D. DPPS
Pediatrician
License #: ______________________________

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CHILD ADMISSION HEALTH INTAKE
Child’s Name: __________________________________________ Age: ________________________
Date of Birth: ___________________________________________ Sex: ________________________
Color: Skin: _________________ Eyes: ____________________ Hair: ______________________
Vision: ___________________________________ Ears:
_____________________________________
Nose: ____________________________________ Teeth:
____________________________________
Throat: ___________________________________ Heart:
____________________________________
Chest: ____________________________________
Abdomen:_________________________________
Posture: __________________________________ Spine:
___________________________________
Legs: ____________________________________ Feet:
_____________________________________
Skin: ____________________________________ Genitalia: _________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
114

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__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
115
Date:
Physician

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J O I N T A F F I D A V I T
116
I, __________________________________, of legal age, ___________ and resident of
________________________________ and _________________________, of legal age,
________________ and a resident of _______________________________ after having duly sworn in
accordance with the law depose and say:
1. That we personally know Maricel Monteo Romero, a former resident of
________________________________________;
2. That we personally know that Maricel Monteo Romero begot a baby girl named
RACHEL JOY ROMERO, born on August 29, 2002 at _________________________;
3. That the birth of the said child was not registered at the Book of Civil Registry of the
Municipal Civil Registrar of Taytay, Palawan;
4. That we are not related either by consanguinity or by affinity to Rachel Joy Romero;
5. That we freely and voluntarily execute this affidavit to affirm or oath the above-mentioned
facts.
IN WITNESS WHEREOF, we have hereunto set our hand on this ____ day of
____________ at Taytay, Palawan.
____________________________ ____________________________
Affiant Affiant

Forms
SUBSCRIBED AND SWORN TO BEFORE ME this ___ day of ____________ 2003 at Taytay,
117
Palawan; Affiant exhibited to me their CTC No. _____________ and _________________ both
issued at Taytay, Palawan on ____________ and __________, respectively.
Doc. No.
Page No. _______________________
Book No. Notary Public
Series of 20_ _

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118
C E R T I F I C A T I O N of Appearance
TO WHOM IT MAY CONCERN:
This is to certify that Ms. ____________, social worker of Aloha House Orphanage has
appeared to my office/ residence on the ______day of _____________, 2002 for the purpose of
__________________________________________________________________________________
______________________________.
__________________________
Signature over printed name
_______________________________________________
_______________________________________________
Address
WITNESS:

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119
FOR PUBLICATION: Abandoned Child
Calling the attention of Mr. and Mrs. _______________ and the relatives of a baby boy
named _______, born on June 20, 2001 at the Palawan Provincial Hospital, Puerto
Princesa City.
The baby is presently under the custodial care of Aloha House Orphanage located
at Abad Santos Ext., Puerto Princesa City.
Please visit, write or contact the said orphanage at telephone no. 434-5640. You can also coordinate with
the Department of Social Welfare and Development Office (DSWD)-Palawan Liaison Desk at City Hall Complex,
Tiniguiban heights, Puerto Princesa City or call them at telephone no. 434-3307.

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Minutes of Admission Conference
120
Date: _________________
I. Basic Information of the Client
Name of the client: ______________________________________________ Age:
_________________
Place of Birth: _____________________________________ Date of Birth:
_______________________
Father: ________________________________________________________ Age:
_________________
Address:
______________________________________________________________________________
Mother: _______________________________________________________ Age:
_________________
Address:
______________________________________________________________________________
II. Reasons for Referral/ Background of the Situation or Problem
III. Health Condition of the Client
IV. Conditions and Agreement of Placement

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121
V. Contact Persons/ Significant Others
Name Relationship to the client Address
1.
2.
3.
4.
5.
VI. Treatment Plan
Referring Party:
Caring Agency:
VII. Others
Minutes taken by:
Noted by:

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______________________
122
________________________

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123
TRANSMITTAL MEMO
Date: _____________________
TO: ___________________________________
FROM: ________________________________
Subject: ___________________________________________________________________________
Enclosed are the following documents:
_________ Child Study Report
_________ Birth Certificate
_________ Certificate of Foundling
_________ Deed of Voluntary Commitment
_________ Abandonment Decree
_________ Child Profile
_________ Updated Child Profile
_________ Medical Certificate
_________ Updated Medical Report
_________ Immunization Record
_________ Pictures ( ___ copies, ___ full sized ___ passport size )
Others: _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Forms
124
Remarks: _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Sent by:
_________________________________
Received by:
_________________________
Date received: _________________________

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125
A U T H O R I Z A T I O N
This is to authorize MS. ROSLYNN AURELIO, our volunteer to get the ultrasound of JAY
CLESTER ACOSTA from the records section of Palawan Adventist Hospital. He was admitted
last January 8, 2003.
Such record is badly needed as he is to be referred to Manila today.
Done this 14th day of March 2003 at Puerto Princesa City, Palawan.
Thank you.
Signed by:
ANNACAR L. BILLANO, RSW
Social Worker

Forms
Visa Medical Expense Form
126
Date: ___________________
To: ______________________________
Re: Total Expenses for Visa-Medical of:
1. Abraham Martin Bacaltos
2. Stanlee Garry Dugenia
Airfare : PPC to Manila -
Manila to PPC -
Housing -
Food -
Taxi -
TOTAL Expenses for 2 wards - _______________________

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Please deposit to Aloha House, Inc. Account # 0424-01216-5, Equitable-PCI Bank
– Puerto Princesa City branch.
127
Signed:
Keith O. Mikkelson
Executive Director

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DEFERMENT SLIP
128
Date:
Child’s Name :
Age/ Sex :
DOB :
POB :
Status :
Category :
CCA :
CCA Social worker :
CCA Supervisor/ ED :
Clearance for ICA :
Rec’d by ICAB :
Secretariat SW :
Supposed Schedule of Presentation :

Forms
129
Reasons for Deferment : Requested New Schedule of Presentation

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Medical Records Clerk
Palawan Adventist Hospital
Puerto Princesa City
Madam:
130
We are an NGO licensed as Child Caring and Child Placing Agency operating for 3 years now. We
are facilitating the permanent placement of children in our care who are legally free for adoption.
When the Child Study Report pertinent files of _____________ were received by the DSWD
Central Office in Quezon City, it was noted that there was a flaw in the preparation of the Certificate of
Live Birth which was incurred in the Local Civil Registrar’s Office. We were requested to submit a clean
copy of the said Birth Certificate.
In view thereof, we are requesting for assistance to reconstruct a clean Birth Certificate copy for
_________________________.
Further request favorable approval.
Thank you.
Respectfully,
Cristina T. Velasco, RSW
Social Worker
Aloha House Inc.
Noted by:

Forms
131
Keith O. Mikkelson
Director
Aloha House Inc.
.
Recommending Approval:
Herminia R. Parales
City Civil Registrar
Puerto Princesa City
Attached: Copy of Birth Certificate

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D I S C H A R G E F O R M
132
January 8, 2004
This is to certify that Aloha House has discharged:
Name of the child/ minor : __________________________________
Sex : Male
Birthdate : November 14, 2002
Birthplace : Provincial Hospital, Puerto Princesa City
Date admitted : November 15, 2002
Age upon admission : 1 day old
Age upon discharge : 1 year 1 month
Length of stay : 1 year 1 month
Health/ Physical Condition : Healthy
Discharged by:
KEITH O. MIKKELSON ANNACAR L. BILLANO, RSW
Executive Director Social Worker
Hereby received the aforementioned child/minor:

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133
______________ _____________
Adoptive Father Adoptive Mother
Address:
WITNESSES:
Narcisa S. Mikkelson Cristina T. Velasco, RSW
Assistant Director Social worker

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JOINT AFFIDAVIT
134
We, Narcisa S. Mikkelson, of legal age, with residence and postal address at 28-C Libis Rd., San
Pedro, Puerto Princesa City, and Cristina T. Velasco, of legal age, with residence and postal address at
088 Brgy. Seaside, Puerto Princesa City, after having been sworn to in accordance with law, hereby depose
and say that:
1. That, we know Rosana Bunda for over two years now;
2. That, we know for a fact that she has been known in this name since;
3. That, Rosana Bunda had been a client of a Child Caring and Child Placing institution in San Pedro,
Puerto Princesa City named Aloha House Inc., and the said institution referred the minor on June 5,
2001 to another Child Caring institution in Antipolo City named Christian Compassion Ministry;
4. That, Rosana Bunda was orphaned by her father, Eduardo Bunda, in 1995 and abandoned by her
mother, Sally Balboa, since 1988;
5. That, Aloha House Inc. registered Rosana Bunda’s birth at Puerto Princesa Civil Registrar’s Office
in September 2002, and it appeared in the Certificate of Live Birth the name Rosana Balboa for the
reason that the father could no longer acknowledge his paternity over the subject minor as he is
deceased.
6. That, Narcisa S. Mikkelson and Cristina T. Velasco being the Assistant Director and Social Worker
of Aloha House Inc. respectively, attest to the truth that Rosana Bunda, as appearing in all her
records in school and in Aloha House Inc., and Rosana Balboa, as entered in her Certificate of Live
Birth are one and the same persons;
7. That, ROSANA B. BUNDA, and/ or ROSANA BALBOA, has no intention to defraud the public
the fact of her legal personality.

Forms
8. That, we are executing this affidavit to attest to the truth of the foregoing facts and to confirm the
legal personality of ROSANA BUNDA and ROSANA BALBOA which refers to one and the same
person.
IN WITNESS WHEREOF, we have hereunto set our hand this ___________________________ at
135
Puerto Princesa City, Philippines.
Narcisa S. Mikkelson Cristina T. Velasco
( Affiant ) ( Affiant )
Res. Cert. # 00952664 Res. Cert. # 16149905
Issued on 1/ 10/ 2002 Issued on 2/ 11/ 2002
At Puerto Princesa City At Puerto Princesa City
SUBSCRIBED AND SWORN to before me this _______________________
at Puerto Princesa City, Philippines.
Doc. No. ____________
Page No. ____________
Book No. ____________
Series of ____________

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JOINT AFFIDAVIT
136
We, _____________________________ and _____________________________
both of legal age, husband and wife and residents of _____________________________
______________________________, Puerto Princesa City, after having been sworn to in accordance
with law hereby depose and say:
The baby/ babies named ______________________________________________
________________________________________________________________________
________________________________________________________________________
was/ were born to us without the benefit of marriage sometime on _________________
________________________________________________________________________
That we have been living together as husband and wife for ________ years now;
That sometime on _________________________________, we contracted marriage before
__________________________________________________________;
That we are executing this affidavit to attest to the truth of the above statements and to comply
with the requirement of the law for the purpose of legitimizing our said child/ children.
IN WITNESS WHEREOF, we have hereunto set our hands this _________ day of
_____________________ in Puerto Princesa City.

Forms
137
__________________________________ __________________________________
(Affiant) (Affiant)
SUBSCRIBED AND SWORN to before me this ____day of _____________
in Puerto Princesa City, affiant exhibiting to me their Community Tax Nos. ___________
and _____________ issued on ______________________ and ____________________
at Puerto Princesa City.

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138
C E R T I F I C A T I O N
This is to certify that child, _________________, is a client of this office. Based on
the social case study we conducted, the family’s status is considered as indigent. The child
was surrendered by his mother for adoption and was referred to Aloha House Inc. for care
and facilitation of his permanent placement.
Done this ____ of August 2002 at Puerto Princesa City.
Ms. Leonila C. Mojal, RSW
SWO III, CSWD
Noted by:

Forms
139
Ms. Lolita C. Yulo, RSW
City Social Welfare Officer

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MEDIA CERTIFICATION
140
This is to certify that the herein below described minor has been aired over the TV/Radio Program
indicated below.
This certification is issued upon the request of Aloha House Orphanage and Department of Social
Welfare and Development- Regional Office IV for the purpose of filing the petition for Abandonment/
Involuntary commitment of the said minor.
Name: Sex:
Nickname: Age:
Birthplace: Birthdate:
Weight: Height:
Body built: Health status:
Complexion:
Mother:
Father:
Last Known Address:
If foundling, Date found:
Place found:
Person who found the child:
Address:
TV/Radio Company: _______________________
Dates Aired: _______________ Time Aired: __________________

Forms
141
Announcer: _________________________
( Signature above printed name)
Witnesses: ___________________________
___________________________
Atty. Dulfie Tobias-Shalim
Director / DSWD Region IV

Forms
To: The Radio Announcers
142
RGMA-DYSP Super Radyo
From: Aloha House Orphanage
Re: PANAWAGAN
Dear Sir or Madam:
We would like to request for your public service of airing our panawagan. This is in connection to our
efforts to locate the parents of Gabriel Erato, who left the child at the Provincial Hospital. We need
Media Certification from Radio, Newspaper and Television that we had aired/published this notice to the
public in 3 consecutive weeks for the purpose of filing the petition of abandonment of the said minor.
Dates of airing: December 13-14, 2001
We would greatly appreciate your help for the institution.
Thank you.
Respectfully,
Keith O. Mikkelson

Forms
143
Director
Aloha House Orphanage

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Foundling Media Announcement
144
December 5, 2001
___________________,
Nais pong ipaalam ng institusyong ito na ang inyong anak na si ___________________ na
isinilang noong June 20, 2001 sa Palawan Provincial Hospital dito sa Lungsod ng Puerto Princesa ay
nasa aming pangangalaga. Ang inyo pong anak ay inilagak ng Department of Social Welfare and
Development Office (DSWD) sa institusyong ito sa kadahilanang walang mag-aaruga at magbibigay
ng mga pangangailangan ng inyong anak na noon ay nasa Ospital. Amin pong kinikilala at iginagalang
ang inyong karapatan bilang mga magulang ni ___________________kung kaya’t ipinaaalam namin
sa inyo na siya ay nasa mabuting kalagayan at kami po ay nakahandang ibigay ang inyong anak kung
kayo po ay may kaloobang siya’y kunin at alagaan. Ano man ang nais ninyong mangyari o anuman
ang inyong plano para kay ___________________ ay nais po namin itong malaman. Handa po kaming
makinig sa anumang kadahilanan at kung ano man ang inyong naging sitwasyon at kasalukuyang
sitwasyon kung kaya kayo po ay nabigong balikan at kunin ang inyong anak na nasa ospital. May mga
karapatan po ang isang bata na dapat ay tugunan ng kanyang mga sariling magulang. Ang sino man
pong bata na hindi nabigyan ng tamang pangangalaga ng magulang o iniwan o pinabayaan ng kanyang
mga magulang sa loob ng anim na buwan ay maaaring ideklara ng hukuman bilang isang
inabandunang bata. Sa gayon, mawawala ang karapatan ng magulang sa kanyang anak at ang bata ay
hahanapan ng ibang pamilyang magmamahal at mag-aaruga sa kanya.
Kung kayo po ay nagnanais na kunin ang inyong anak, maaari o kayong bumisita sa Aloha
House, Inc. na matatagpuan sa Abad Santos Ext., Lungsod ng Puerto Princesa. At kung kayo po ay
hindi makakadalaw sa anumang kadahilanan, maaari po kayong sumulat o dili kaya ay tumawag sa
numerong ito: 434:5640.
Inaasahan po namin ang inyong agarang katugunan. Maraming salamat.
Gumagalang,

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Cristina T. Velasco
Social worker, Aloha House

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D E E D O F V O L U N T A R Y C O M M I T M E N T
KNOW ALL MEN BY THESE PRESENT:
146
I/WE ____________________________________________, Filipino, __________ years old and
_____________________________________, Filipino, _________ years old and with residence postal address at
____________________________________________________________________, having been duly sworn in
accordance with law, do hereby depose and say.
That I/we am/are the parent/s of the child/ren, ______________________________________,
born on ______________________ at _____________________________________________________;
That I/we am/are unable to care for and support the aforenamed child/ ren and believe that the welfare of
said child/ ren will be best protected by committing her/ him to the care of the government;
That I/we voluntarily and unconditionally commit said child/ ren to the care and custody of the
Department of Social Welfare and Development the custody and control of said child/ ren pursuant to the
provisions ( Article 154/ 155 ) of Presidential Decree No. 603, Child and Youth Welfare Code;
That I/ we hereby authorized the Department of Social Welfare and Development to release said
child/ren for adoption or guardianship either locally or abroad without notice to me/ us and give consent to such
adoption or guardianship as if I/we personally gave such consent that terminates the pre-existing legal
parent-child relationship between the child and her parents;
That I/we further believe that the placement of said child/ren in an adoptive home at the earliest
possible time will serve his/ her interest in enhancing his/ her normal growth and development;
That I/we have not received any payment, compensation or any consideration, monetary or in kind for
the purpose of making this commitment;
This voluntary and unconditional commitment of my/our child/ren to the Department of Social Welfare
and Development shall become irrevocable six months after the execution of this document;

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I/ We declare that I/we have fully understood the above statements.
IN WITNESS WHEREOF, I/ we have hereunto set my/ our signature/s this ___________day of
_____________200____ at _____________________________________________.
___________________________ _____________________________
Signature of Father Signature of Mother
___________________________ _____________________________
Left Right Thumb Mark Left Right Thumb Mark
SIGNED IN THE PRESENCE OF:
___________________________ _____________________________
A C K N O W L E D G M E N T
BEFORE ME, NOTARY PUBLIC, for and in the City/Municipality of__________________, this___day
of____________20__ personally appeared___________________and__________________ with Community Tax
Certificate Nos ___________________ issued on ________________at ________ known to me to be the same
person(s) who executed the foregoing Deed of Voluntary Commitment and acknowledge to me that the
same is her/ his own free and voluntary act and deed.
WITNESS WITH MY HAND AND SEAL on the date and at the place first above written.

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NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No. :__________
Series of 20_________

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149
C E R T I F I C A T I O N Structural Safety
Residential Building
This is to certify that the one-storey Residential Building at 28-C Libis, San Pedro, Puerto Princesa
City, presently occupied by Aloha House, has passed a Structural Safety examination by the undersigned. It
is found built in accordance with the National Building Code currently enforced in the Republic of the
Philippines and safe for occupation for Aloha House Inc.
This certification is issued upon request of Mr. Keith O. Mikkelson, Aloha House representative
for whatever purpose it may serve them.
Signed this 15th day of February 2002 at 28-C Libis, Puerto Princesa City, Palawan.
RAMEL L. VALOROSO
Civil Engineer
PRC LIC NO. 68387
PTR NO. 3800949 W
Date Issued: 1-25-02
Issued at: Pto. Princesa City

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KATUNAYAN 1
Ito ay pagpapatunay na ako, si Mrs. __________, 44 taong gulang at
nakatira sa Bgy. Luzviminda ay pinahihintulutang magtrabaho habang nag-aaral
ang aking anak na si ____________, 15 taong gulang, para sa Aloha
House Inc. Si ___________ ay kasalukuyang nasa pangangalaga ng naturang
institusyon na nasa ilalim ng pamamahala ni Ginoong Keith O. Mikkelson.
Lagda:
_____________________ ___________________
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Keith O. Mikkelson
Petsa: Director/ President

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CERTIFICATION
June 27, 2001
This is to certify that minor John Gamot, 10-month-old, is transferred from the custody of
foster parents Keith Narcy Mikkelson to Aloha House Inc. with DSWD licensed # 01-IV-022, under
the direction of Mr. Keith O. Mikkelson.
Signed: Received by:
_____________________ ______________________
Keith O. Mikkelson Cristina T. Velasco
Director/ President Social worker
_____________________
Narcisa B. Mikkelson
Vice-President

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Initial Family Assesment Form
Name:
Address:
Contact method: Phone, Neighbor’s phone, Pastor, _________________
Name of Spouse / Live – in:
Employment:
Children-Names/Ages:
Refered by:
Problem:
Observations:
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1:
2:
Prepared by:

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155
Evaluation of Worker- Name:__________________
Date Accepted to Work: January 15, 2001
Terms Conditions: Probationary Househelp for Three (3) Months
EVALUATION
I. Areas Appreciated: Lively Desposition and Not Shy. Willingness to Learn. Able to work with
others without friction or faction.
II. Areas That Need to be Improved
a. work attitude - initiative in starting and doing jobs without being instructed
b. foresight - planning work in advance with minimum supervision
c. Team Work - helping others do their share of work even if it is outside their responsibility
d. Jobs Not Properly Done - cleaning and following through the maintenance of the house
- floor
- windows
- cupboards and ref tops
- furniture
- office floor and table
- hanging flowers
-
III. Telephone Calls
- This is a Business Phone. We have talked about its use and we get phone calls that are
unnecessary and at unholy hours
-
IV. Going Out
- It should be limited and if possible be delegated and planned ahead and be cleared all
the time.
General Evaluation: In a range of 1-10. General Performance is ____. Therefore not recommended for
Permanent Work.
Evaluated by:

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NARCY MIKKELSON NOTED BY:
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KEITH O. MIKKELSON

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C E R T I F I C A T I O N of Discharge
This is to certify that ALOHA HOUSE ORPHANAGE has discharged the living body of 1 year and 8 months old
____________________, in good health condition, to Mr. And Mrs________________by the order of the DSWD social worker, Mrs.
_______________.
Signed this __________ day of ____________, 2001 at Puerto Princesa City, Palawan.
Keith O. Mikkelson
Director
Received by:

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GENOGRAM CHECKLIST
( For Social Worker’s Use )
Date: _____________
Client:____________________________
FAMILY MYTHS AND BELIEFS ABOUT PARENTING
1. Parenting to children – Is there any evidence of abuse/ escape goating in the extended family?
____________________________________________________________________________
____________________________________________________________________________
Attitudes, values about parenting: _________________________________________________
____________________________________________________________________________
Attitudes to Children – Comment on sizes of families:_________________________________
____________________________________________________________________________
Child or adult centered? _________________________________________________________
____________________________________________________________________________
Specific roles assigned to children? ________________________________________________
____________________________________________________________________________
2. Family Patterns – Behavioral Patterns – Any family patterns emerging e.g. oldest children
don’t marry, divorces, separations: ________________________________________________
____________________________________________________________________________
Attitudes to education:_________________________________________________________
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Mobility:____________________________________________________________________
Involvement in foster care:______________________________________________________
____________________________________________________________________________
3. Extended family supports and networks – Are relationships supportive or obstructive?_______
____________________________________________________________________________
Who supports whom?__________________________________________________________
____________________________________________________________________________
Are there any dependent relatives?________________________________________________
Whose responsibility are those members? __________________________________________
____________________________________________________________________________
4. Health Patterns – Is there any evidence of inherited diseases: ___________________________
Early death:______________________ Psychiatric illness/condition:_____________________
Other health problems (present):__________________________________________________
Past health problems:___________________________________________________________
____________________________________________________________________________
5. Occupational Expectations- What kind of work are various members doing?_______________
____________________________________________________________________________
____________________________________________________________________________
Is this a professional family? _____________________________________________________
Is there evidence of disappointment about specific members achievements? ________________
_____________________________________________________________________________
_____________________________________________________________________________
Expectations on children: ________________________________________________________
_____________________________________________________________________________
6. Family views on
Illness:_______________________________________________________________________

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_____________________________________________________________________________
Disability: ____________________________________________________________________
_____________________________________________________________________________
“Different People”, including cultural differences :____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
7. Mobility of Extended Family – Any patterns of tran science? ___________________________
_____________________________________________________________________________
8. Loss – has any of the family lost a child? ___________________________________________
What were family reactions to this? ________________________________________________
____________________________________________________________________________
Are grief issues resolved? _______________________________________________________
_____________________________________________________________________________
Other losses:
Migration: _____________________________________________________________________ financial change
:________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________
Other important notes:
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RELATIONSHIP AND INDIVIDUAL FUNCTIONING QUESTIONAIRE
For Female
161
Relationships:
(i) Current
1. How did you meet your current partner?____________________________________________
______________________________________________________________________________
2. What attracted you to him/ her?___________________________________________________
______________________________________________________________________________
3. How long have you been in this relationship?________________________________________
4. Have you ever lived apart?_______________________________________________________
5. Is there anything you can think of that could disrupt your current relationship?_____________
______________________________________________________________________________
6. What do your respective families think about this relationship?_________________________
______________________________________________________________________________
7. What do you like most about your partner?__________________________________________
______________________________________________________________________________
8. What do you find most difficult to talk about your relationship with your partner?___________
______________________________________________________________________________
9. When you talk with each other, what do you talk about?_______________________________
______________________________________________________________________________
10. What things do you find difficult to talk about with your partner?_______________________
______________________________________________________________________________

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11. What do you and your partner tend to
a. agree about:_______________________________________________________________
162
__________________________________________________________________________
b. disagree about: ____________________________________________________________
__________________________________________________________________________
12. How do you manage a difference of opinion?_______________________________________
______________________________________________________________________________
13. When you feel angry with your partner how do you show it?___________________________
______________________________________________________________________________
14. When your partner feels angry with you how does he/ she show it?______________________
______________________________________________________________________________
15.Do disputes get resolved at the time or are they put on hold?___________________________
16. What is your definition of violence? ______________________________________________
17. Has there been any violence between you?_________________________________________
18. When you are having a disagreement, what happens to the children?____________________
______________________________________________________________________________
19. How do you show affection and caring toward each other?____________________________
______________________________________________________________________________
20. What are some of the other ways that you and your partner show closeness and intimacy?___
______________________________________________________________________________
21. How important do you consider your sexual relationship as an expression of intimacy?______
______________________________________________________________________________
22. Overall, are you happy with your sexual relationship?________________________________
How do you think your partner would answer this question?______________________________
23. How difficult is it to talk with your partner about sexual issues?________________________
______________________________________________________________________________

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24. Have you been in a close relationship previously?___________________________________
If so, what were these relationships like?_____________________________________________
______________________________________________________________________________
How did it end and how did you feel about that?_______________________________________
______________________________________________________________________________
______________________________________________________________________________
FAMILY OF ORIGIN:
We learn about relationships and parenting in our own families. We need now to ask some questions about
your family of origin.
1. How did your family show affection towards each other?______________________________
______________________________________________________________________________
2. How did your parents show affection towards each other?______________________________
3. How did your mother/ father show affection towards you? How satisfied were you with this level of
affection?_______________________________________________________________
______________________________________________________________________________
4. Were there times when you would have preferred them to show their affection differently?____
______________________________________________________________________________
5. As a child, did you ever feel uncomfortable with the way someone expressed affection towards you? (P Char
#5)________________________________________________________________
a. If so, did this discomfort stem from any invasion of your personal space or body e.g. inappropriate fondling or
petting? __________________________________________________
b. If so, were you able to talk to anyone about this at that time?___________________________
c. Or later in life?________________________________________________________________
d. Does your partner know about this?_______________________________________________
6. In what ways were you aware of developing sexuality as a child and teenager?_____________

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______________________________________________________________________________
7. At around 16 years of age, did you date quite often? (P Char #)_________________________
Did you date about as often or more frequently than others in your peer group?_______________
8. Was there any discussion about sexual issues in your home?____________________________
9. How did your parents show their anger towards each other?____________________________
______________________________________________________________________________
10. How did you show anger towards your mother/ father?_______________________________
______________________________________________________________________________
How did they respond?___________________________________________________________
11. How did you show anger towards your siblings?____________________________________
______________________________________________________________________________
How do they respond?____________________________________________________________
12. Did the disputes get resolved at the time or were they put on hold?______________________
13. What disciplinary measures and punishments did your parents use?_____________________
______________________________________________________________________________
14. Were all the children in the family disciplined in the same way?________________________
15.How do you think your mother/ father were parented?________________________________
______________________________________________________________________________
16. Can you recall excessive use of alcohol or other substances by your parents/ caregivers?
______________________________________________________________________________
17. How many members of your extended family suffered from a psychiatric illness/condition?
______________________________________________________________________________
Parenting:
1. What was the time of pregnancy like for you? _______________________________________
2. Were there any complications during any pregnancy or, during/ after delivery e.g. post natal
depression?_____________________________________________________________________
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3. What was it for you as parents when your children were babies?_________________________
______________________________________________________________________________
4. Describe your respective roles in caring for the children when they were small. How did you feel about
that?__________________________________________________________________
5. Describe your roles in looking after your children now?________________________________
______________________________________________________________________________
6. Have the children required medical attention, hospitalization or educational/ allied health assessments? _____ If
so, how has the family dealt with this?_____________________________
______________________________________________________________________________
7. How do you and your partner show affection and caring towards your children?____________
______________________________________________________________________________
Discipline:
8. What disciplinary measures and punishment do you use/ your partner uses? ________________
______________________________________________________________________________
______________________________________________________________________________
9. When would you get angry with your children and how do you show it?__________________
______________________________________________________________________________
10. How does your partner show it?_________________________________________________
11. How does your children show that they are angry with you?___________________________
______________________________________________________________________________
12. How do you/ your partner respond to their anger?___________________________________
______________________________________________________________________________
13. Do you deal with all the other children in the same way?___________ or do they respond to different
things?_________________________________________________________________
14.Would you like to have more children of your own?__________________________________

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Sexuality:
1. How do you/ would you discuss sexual issues with your children?_______________________
______________________________________________________________________________
2. Do you think your child your child would talk with you if they had been sexually abused? ___________ Would
they talk to anyone else?_________________________________________
3. How would you respond if the abuser was in the family?_______________________________
______________________________________________________________________________
Outside the family?______________________________________________________________
______________________________________________________________________________
4. What do you consider to be pornography?__________________________________________
______________________________________________________________________________
5. What place does it have in your family?____________________________________________
6. Would a child be able to have access to any sexually explicit material in your home?________
7. How would you respond if your child had been exposed to sexually explicit and/ or pornographic
materials?__________________________________________________________
8. In what ways do you think this might be different for a child who had been sexually abused?
______________________________________________________________________________
Finances:
1. How would you rate your financial security on a scale of 1-10 (10 being very secure)?_______
Explain your reasons for this score:__________________________________________________
______________________________________________________________________________
2. How are finances managed in your family?__________________________________________
______________________________________________________________________________
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3. How do you decide how the money will be spent?____________________________________
______________________________________________________________________________
4. Who has the final say?__________________________________________________________
5. Who would be more likely to think that a foster child/ adoptive child might strain your financial
security?_______________________________________________________________
6. Do your children get pocket money?_______________ If so, how is the amount decided upon?
______________________________________________________________________________
7. Are you financially responsible for anyone outside the family e.g. elderly parents, children from previous
relationship?________________________________________________________
SOCIAL NETWORKS AND SUPPORT SYSTEMS:
(These questions may have already been answered during the administration of the eco-map).
CURRENT:
1. Who are your close friends?_____________________________________________________
______________________________________________________________________________
2. Who are your partner’s close friends?______________________________________________
______________________________________________________________________________
3. Who does the family socialize with most e.g. work, family, friends, church?_______________
______________________________________________________________________________
4. In your extended family, who do you have most contact with and how often?_______________
______________________________________________________________________________
5.If something is bothering you, who is the person you would turn to first e.g. spouse, family, friend, other?
___________________________________________________________________
6. To what extent are the following statements true?

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My friend tend to be much younger than I YES NO
Children like me know how to listen to them YES NO
I prefer the company of children to that of adults YES NO
I tend to think of children as very innocent or pure YES NO
My friends tend to be much older than older than I YES NO
PAST:
7. Which of the following statements would you say were true about you when you were around 16 years of age?
I had many close male friends YES NO
I had few close male friends YES NO
I had many close female friends YES NO
I had few close female friends YES NO
I wish I had more male friends YES NO
I wish I had more female friends YES NO
I felt pretty lonely most of the time YES NO
I had a close friend at 5 years older than
with whom I spent a lot of time YES NO
I had a close friend at 5 years younger
than I with whom I spent a lot of time YES NO
8. How many times have you moved since you were 18 years of age?_______________________
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LEISURE TIME:
1. What things do your family do together?___________________________________________
______________________________________________________________________________
2. What things would you like to be able to do as a family?_______________________________
______________________________________________________________________________
3. What things do members of the family do on their own?
a) Self:_______________________________________________________________________
b) Partner:____________________________________________________________________
c) Children:___________________________________________________________________
____________________________________________________________________________
4. Do you have favorite hobbies and interests that you feel would appeal to a child?___________
If yes, what are some of these favorite hobbies and interests? (P Char.# 9) ___________________
______________________________________________________________________________
How does the family spend vacation time?____________________________________________
______________________________________________________________________________ How is it spent
together?__________________________________________________________
STRESSORS:
1. What are the things that give stress on this family? Do they have to do with work, finances, friends, family,
children or other things?______________________________________________
______________________________________________________________________________
2. What are the signs of stress? _____________________________________________________
______________________________________________________________________________

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3. How do you respond to these signs? _______________________________________________ Would you seek
professional counseling if appropriate?_________________________________
4. What has your family been most concerned about in the last six months?__________________
______________________________________________________________________________
5. How have you felt about this interview?____________________________________________
FOSTERING/ ADOPTING A CHILD:
1. What are the main reasons that you wish to foster/ adopt a child? ________________________
______________________________________________________________________________
2. What does this family have to offer a foster/ adoptive child?___________________________
______________________________________________________________________________
3. What expectations do you have of this child?________________________________________
______________________________________________________________________________
4. Do you consider that this child will alter your time commitments?______ How? ____________
______________________________________________________________________________
5. What changes will you have to consider as an individual/family? ( e.g. after school, therapy sessions,
etc.)___________________________________________________________________
6. What changes will you have to make to protect your family from allegations of abuse (e.g. in house nudity,
physical discipline, bed sharing etc.)______________________________________
______________________________________________________________________________
7. What difficulties do you think a foster/ adoptive child would have in fitting in with your
family?________________________________________________________________________
8. How would a foster/ adoptive child fit into your family who:
a) has no cultural/ religious beliefs?________________________________________________
_____________________________________________________________________________
b) has different cultural/ religious beliefs to your own?_________________________________
_____________________________________________________________________________
9. What effect do you think fostering/ adopting a child will have on each of your children?______
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______________________________________________________________________________
10. Who in your family most wants to foster/ adopt a child?______________________________
What are their reasons for this?_____________________________________________________
______________________________________________________________________________
11. Is there anyone in your family who thinks that fostering/ adopting a good idea?____________
If there isn’t one who would be most likely to have some doubts?__________________________
12. Is there anyone of your family of origin or social network who thinks that it is/ is not a good idea?
_________________________________________________________________________
What reasons do they give for these opinions?_________________________________________
______________________________________________________________________________
13. If the foster/ adoptive child has access to his/ her natural parents, what difficulties can you foresee that may
arise?
a) for the foster child:____________________________________________________________
b) for your family:_______________________________________________________________
c) for the natural parents: _________________________________________________________
14. If you were approved to foster/ adopt a child, there would be a matching process to ensure the suitability of the
placement for the particular child. Do you have any specific preferences in the following areas?
a) Race of child (circle answer)
An aboriginal child YES NO
An Asian child YES NO
A white Australian child YES NO
A mixed race white child YES NO
Other, specify:____________________________________________________________
b) Age of child
0-5 years YES NO 11 years YES NO
6 years YES NO 12 years YES NO

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c) How willing would you be to accept a child with the following histories?
A child with a history of a medical problem YES NO
A child with a history of medical problems YES NO
A child with a history of trouble with the law YES NO
A child with a history of alcohol abuse YES NO
A child with a history of parental neglect YES NO
A child with a history of physical abuse YES NO
A child from low income family YES NO
A child with a history of sexual abuse YES NO
A child with a history of emotional abuse YES NO
A child from a housing trust area YES NO
A child with low self-esteem YES NO
A child who has previously been in foster care YES NO
A disabled child YES NO
A hyperactive child YES NO
A child who is inactive in sports YES NO
A child who is unkempt YES NO
A child who uses bad language YES NO
A child who is introvert YES NO
A child who gets into fights YES NO
A child who has no/ few friends YES NO

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A child who smokes YES NO
15. Have you been associated with any child caring/ training/ activity groups? If yes, give name of
group/s._____________________________________________________________________
16. Have you had any experience working with children? ____ In what way?________________
_____________________________________ What are these experiences?__________________
______________________________________________________________________________
17. How would you cope with not being approved as a foster caregiver or with not being approved to
adopt?_______________________________________________________________
______________________________________________________________________________
Respondent:
______________________________
Signature above printed name

Aloha House Manual updated 2014

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Aloha House Manual updated 2014