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 ........................................................ Error! Bookmark not defined.

C. Types of Play equipment and materials ...................................................... Error! Bookmark not defined.

3. To develop expression and skill: ....................................................................... Error! Bookmark not defined.

4. To stimulate imitative play and develop imagination: ............................ Error! Bookmark not defined.

5. Suggestions for Emotional Development ....................................................... Error! Bookmark not defined.

D. Adoption ................................................................................................................ Error! Bookmark 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 .............................................................................................. Error! Bookmark not defined.

5. Caregiver ................................................................................................................................................................................... 64

6. House Parents ............................................................................................................ Error! Bookmark 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 ............... Error! Bookmark 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

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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

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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.

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

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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.

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


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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.

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

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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.


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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:

a. in crisis

b. without families

c. abandoned

d. surrendered

Mission, Goals and Objectives

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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.


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Abandoned and Surrendered Children

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


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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 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


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occurring in the High schools and colleges here through abortion. This is genuine pro-life mission.

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


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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.

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


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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.


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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 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.


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III. Clientele

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

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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.


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General Policies

23


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IV. Geographical Area of Coverage

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

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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.

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


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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

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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


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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

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! authorities or the police ! any other agencies


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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 ! delegate resources when quality programs can be

co-developed

3.) Livelihood Programs

General Policies

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! 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

! delegate resources when quality programs can be co-developed

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)


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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

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! 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

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:


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! 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

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! Health laws ! Home maintenance ! Labor laws ! Water filtration


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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 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

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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


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! 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

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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.


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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.

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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.


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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.

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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.


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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.

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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.


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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.

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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.


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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.

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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.

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:


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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.


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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.


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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


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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:


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" 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 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


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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.

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VII. Organizational Structure

A. Governing Board

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.

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3. Structure

B. Organizational Structure


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C. Communications Flow Chart

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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.


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! 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.

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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; ! Perform such other functions as deemed necessary.


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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.

! Perform such other functions as deemed necessary.

9. Caregivers

! Watches over infants and babies as a mother would her own children.

! Helps in daily duties of the nursery. ! Perform such other functions as deemed necessary.

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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; ! Performs such other functions as deemed necessary;

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 ! Performs such other functions as deemed necessary;


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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; ! Performs such other functions as deemed necessary;

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;

! Performs such other functions as 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;

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! 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;

! Performs such other functions as deemed necessary;

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


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IX. Budget

A. Sources of Funding

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. Expense

371,116 426,783 490,801 564,421 649,085 746,447

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.


70

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.

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;


72

C. Evaluation

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.

DSWD Region 4

President [signatures ]

Social Worker

NGO Treasurer

Outside Accountant

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

President [signatures ]

Social Worker [forms]

Select Annual Reportal Requirements

Lists may be incomplete, requirements change often

DSWD Accomplishment

Report Financial Report

Mayor’s Permit

Medical Exams

Community Tax

CITY HALL

1. Community Tax 2. Barangay Clearance 3. SEC Articles (Xerox) 4. Business 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 S tamped 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.

2 year Work and Financial Report


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


76

B. Medical

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

Purchasing

Stocking

Request for Procurement

Inventory of Stocks

End Users

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

Voucher

Bills Salaries

Donations Income

Posting

Summery of Expenses

Disbursement Check Issuance

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


80

Employee and Volunteers Manual

General Rules:

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

81

• 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.


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

83

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

! 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

85

• 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.

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

86

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

90

____________________________________________________________________________________________________________________________________________________________________________________

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: ____________________________________________________________________

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

92

Birthday & Birth place: ______________________________________________________________________

Dialect/s: _________________________________________________________________________________

Work experience: __________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Previous relationships: ______________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________


__________________________ ___________________________ ________________________________

__________________________ ___________________________ ________________________________


_________________________ ________________ ___________________ __________________________

_________________________ ________________ ___________________ __________________________

_________________________ ________________ ___________________ __________________________

_________________________ ________________ ___________________ __________________________

_________________________ ________________ ___________________ __________________________

_________________________ ________________ ___________________ __________________________

OTHER FINDINGS:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Source/s of Information: _____________________________

_____________________________ Taken by: ______________________

Forms

93

Forms

94

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:

Name Age/Bday Sex Rel. to Child Ed. Attainment Occupation Income

_________________ ___________ ______ ___________ ______________ ______________

_________________ ___________ ______ ___________ ______________ ______________

_________________ ___________ ______ ___________ ______________ ______________

_________________ ___________ ______ ___________ ______________ ______________

_________________ ___________ ______ ___________ ______________ ______________

_________________ ___________ ______ ___________ ______________ ______________

Forms

95

Reasons for Coming to the Institution: ________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________

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

__________________________________________________________________________________________________________________________________________________

Forms

96

Previous relationships:__________________________________________________________________

____________________________________________________________________________________________________________________________________


__________________________ ___________________________ ___________________________


_________________________ ________________ ___________________ _____________________

_________________________ ________________ ___________________ _____________________

_________________________ ________________ ___________________ _____________________

Source/s of Information: _____________________________ ______________________________

_____________________________ ______________________________

Taken by: ________________

Forms

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: _______

Forms

98

Attendant at Birth : ____________________________ Position : _________________________________

Address : ______________________________________________________________________________

Informant : ____________________________________________________________________________

Relation to Child : _______________________________________________________________________

Address : ______________________________________________________________________________

Requirements for Delayed Registration :

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 : _______________________________________________________

Forms

99

Date of Payment : ________________________________________________

Forms

100

PANAWAGAN 1

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

Forms

101

DATE TIME PROGRAM ANNOUNCER

(Printed name & signature)

____________ _________ _________________ ____________________________

____________ _________ _________________ ____________________________

____________ _________ _________________ ____________________________

____________ _________ _________________ ____________________________

Forms

102

PANAWAGAN 2

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.

Forms

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)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Forms

104

Physician’s general observations of the child’s present mental, health & physical condition:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date:

Physician ___________________________________

License # ______________________________

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

Forms

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

108

__________________________________________________________________________________________________________________________________


_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date:

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

Forms

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

110

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:

Forms

111


Physician

Forms

112

CERTIFICATION of Immuniztions

TO WHOM IT MAY CONCERN:

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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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: _________________________________


__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

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__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Date:


Physician

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J O I N T A F F I D A V I T

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

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SUBSCRIBED AND SWORN TO BEFORE ME this ___ day of ____________ 2003 at Taytay,

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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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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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

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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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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______________________

________________________

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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: _______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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Remarks: _______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Sent by:

_________________________________


Received by:

_________________________


Date received: _________________________

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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

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Visa Medical Expense Form

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.

Signed:

Keith O. Mikkelson

Executive Director

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DEFERMENT SLIP

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 :

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Reasons for Deferment : Requested New Schedule of Presentation

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Medical Records Clerk

Palawan Adventist Hospital

Puerto Princesa City

Madam:

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:

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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

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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______________ _____________

Adoptive Father Adoptive Mother

Address:

WITNESSES:

Narcisa S. Mikkelson Cristina T. Velasco, RSW

Assistant Director Social worker

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JOINT AFFIDAVIT

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.

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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 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

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.

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__________________________________ __________________________________

(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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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:

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139

Ms. Lolita C. Yulo, RSW

City Social Welfare Officer

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140

MEDIA CERTIFICATION

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: __________________

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Announcer: _________________________

( Signature above printed name)

Witnesses: ___________________________

___________________________

Atty. Dulfie Tobias-Shalim

Director / DSWD Region IV

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To: The Radio Announcers

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

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Director

Aloha House Orphanage

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144

Foundling Media Announcement

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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145

Cristina T. Velasco

Social worker, Aloha House

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146

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:

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:

_____________________ ___________________

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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153

1:

2:

Prepared by:

Forms

154

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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:

KEITH O. MIKKELSON

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157

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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158

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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159

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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160

_____________________________________________________________________________

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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161

RELATIONSHIP AND INDIVIDUAL FUNCTIONING QUESTIONAIRE

For Female

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:_______________________________________________________________

__________________________________________________________________________

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

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aloha house manual updated 2014

Government & Nonprofit

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