| No. in Admissions Register: | 374 |
| Date of admission: | 6 January 1868 |
| Whence received: | Birmingham |
| By whom brought: | - |
| On what terms: | - |
| Friends interested in him: | - |
| Description: | |
| Height: | - |
| Figure: | - |
| Complexion: | - |
| Hair colour: | - |
| Eyes colour: | - |
| Perfect vision? | - |
| State of health: | - |
| Able-bodied? | - |
| Sound intellect? | - |
| Use of all limbs? | - |
| Had cow or small pox? | - |
| Particular marks: | - |
| Cutaneous disorder? | - |
| Scrofulous or consumptive? | - |
| Subject to fits? | - |
| Age last birthday: | 10 |
| Illegitimate? | - |
| Birthday: | - |
| Birth place: | - |
| Has resided: | Birmingham |
| Parish he belongs to: | - |
| Customary work and mode of life: | - |
| Schools attended: | - |
| By whom and where employed: | - |
| State of education: | |
| Reads: | Not at all |
| Writes: | Not at all |
| Cyphers: | - |
| General ability: | - |
| Offence: | Stealing a box and 4s |
| Circumstances which may have led to it: | - |
| Date of sentence: | 17 December 1867 |
| Where convicted: | Moor Street before G Coe and C Sturge |
| Who prosecuted: | - |
| Where imprisoned: | - |
| Sentence: | 21 days prison (hard labour), 4 years at Saltley |
| Previous committals and convictions: | Two previous convictions |
| Father's name: | Thomas Hickling |
| Occupation: | Scale maker |
| Residence: | back of 39 Lower Essex Street, Birmingham |
| Mother's name: | - |
| Occupation: | - |
| Residence: | - |
| Father's character: | - |
| Mother's character: | - |
| Parents dead? | Mother |
| Survivor married again? | - |
| Parents' treatment of child: | - |
| Character of parents | - |
| Parents' wages: | - |
| Amount parents agree to pay: | - |
| Superintendent of police (to collect payments): | - |
| Relatives to communicate with: | - |
| Person making this return: | - |
| Estimate of character on admission: | - |
| Character on discharge: | - |
| When and how left the Reformatory: | - |
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