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<form class="userform-form" action="" method="post" name="form_5652980" id="5652980" accept-charset="utf-8"><input type="hidden" name="formID" value="5652980" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_3"><div id="cid_3" class="form-input-wide"> <div id="text_3" class="form-html"><p style="text-align: center;"><span style="font-size: 20px;">Child’s Profile – Solon Chabad Preschool</span></p><p style="text-align: left;"> Please take a few minutes to answer the following questions. It will help teachers understand your child better.</p></div> </div></li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Child's Full Name </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q4_fullName[first]" id="first_4" autocomplete="given-name" />  <label class="form-sub-label" for="first_4" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q4_fullName[last]" id="last_4" autocomplete="family-name" />  <label class="form-sub-label" for="last_4" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> What name would you like to appear on the class lists: </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_5" name="q5_input5" size="20" value="" /> </div></li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Does child live with both parents? </label><label class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_6_0" name="q6_input6[]" value="Yes" /><label id="label_input_6_0" for="input_6_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_6_1" name="q6_input6[]" value="No" /><label id="label_input_6_1" for="input_6_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> If no, please explain living arrangements </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <textarea id="input_7" class="form-textarea" name="q7_input7" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_23"><div id="cid_23" class="form-input-wide"> <div id="text_23" class="form-html"><p><strong><span style="font-size:14px;">Please list siblings of the child:</span></strong></p>
</div> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Name: </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_15" name="q15_input15" size="20" value="" /> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Age: </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_16" name="q16_input16" size="20" value="" /> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Do they live at home: </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_8" name="q8_input8" size="20" value="" /> </div></li><li class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> Name: </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_14" name="q14_input14" size="20" value="" /> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Age: </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_17" name="q17_input17" size="20" value="" /> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Name: </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_13" name="q13_input13" size="20" value="" /> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Age: </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_19" name="q19_input19" size="20" value="" /> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Do they live at home: </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_18" name="q18_input18" size="20" value="" /> </div></li><li class="form-line" id="id_21"><div class="form-label-left" id="label_21"><label for="input_21"> Is there a special relationship (other than parents and siblings) that would help us to understand your child better? </label><label class="label-message" for="input_21"> </label></div><div id="cid_21" class="form-input"> <textarea id="input_21" class="form-textarea" name="q21_input21" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> What time does your child usually wake up? </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <textarea id="input_20" class="form-textarea" name="q20_input20" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_22"><div class="form-label-left" id="label_22"><label for="input_22"> What time does your child usually eat breakfast? </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input"> <textarea id="input_22" class="form-textarea" name="q22_input22" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_47"><div class="form-label-left" id="label_47"><label for="input_47"> Does your child have any special food habits? </label><label class="label-message" for="input_47"> </label></div><div id="cid_47" class="form-input"> <textarea id="input_47" class="form-textarea" name="q47_input47" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_46"><div class="form-label-left" id="label_46"><label for="input_46"> What time does your child usually go to bed? </label><label class="label-message" for="input_46"> </label></div><div id="cid_46" class="form-input"> <textarea id="input_46" class="form-textarea" name="q46_input46" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_45"><div class="form-label-left" id="label_45"><label for="input_45"> Are there any special issues with bedtime? </label><label class="label-message" for="input_45"> </label></div><div id="cid_45" class="form-input"> <textarea id="input_45" class="form-textarea" name="q45_input45" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_44"><div class="form-label-left" id="label_44"><label for="input_44"> Does your child sleep well regularly? </label><label class="label-message" for="input_44"> </label></div><div id="cid_44" class="form-input"> <textarea id="input_44" class="form-textarea" name="q44_input44" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_48"><div class="form-label-left" id="label_48"><label for="input_48"> Is your child toilet trained? </label><label class="label-message" for="input_48"> </label></div><div id="cid_48" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_48_0" name="q48_input48[]" value="Yes" /><label id="label_input_48_0" for="input_48_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_48_1" name="q48_input48[]" value="No" /><label id="label_input_48_1" for="input_48_1"><span>No</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_48_2" name="q48_input48[]" value="Working on it" /><label id="label_input_48_2" for="input_48_2"><span>Working on it</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_43"><div class="form-label-left" id="label_43"><label for="input_43"> Does your child use any special words for toileting?  </label><label class="label-message" for="input_43"> </label></div><div id="cid_43" class="form-input"> <textarea id="input_43" class="form-textarea" name="q43_input43" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_42"><div class="form-label-left" id="label_42"><label for="input_42"> Does your child have any special fears? </label><label class="label-message" for="input_42"> </label></div><div id="cid_42" class="form-input"> <textarea id="input_42" class="form-textarea" name="q42_input42" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_41"><div class="form-label-left" id="label_41"><label for="input_41"> Are there any learning issues, vision, hearing, speech or language problems we should be aware of? </label><label class="label-message" for="input_41"> </label></div><div id="cid_41" class="form-input"> <textarea id="input_41" class="form-textarea" name="q41_input41" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_40"><div class="form-label-left" id="label_40"><label for="input_40"> Please list any food allergies that your child has: </label><label class="label-message" for="input_40"> </label></div><div id="cid_40" class="form-input"> <textarea id="input_40" class="form-textarea" name="q40_input40" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_39"><div class="form-label-left" id="label_39"><label for="input_39"> Is there another language spoken at home other than English? </label><label class="label-message" for="input_39"> </label></div><div id="cid_39" class="form-input"> <textarea id="input_39" class="form-textarea" name="q39_input39" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_38"><div class="form-label-left" id="label_38"><label for="input_38"> What method of discipline do you use in your home? </label><label class="label-message" for="input_38"> </label></div><div id="cid_38" class="form-input"> <textarea id="input_38" class="form-textarea" name="q38_input38" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_25"><div class="form-label-left" id="label_25"><label for="input_25"> How do you describe your child’s personality? </label><label class="label-message" for="input_25"> </label></div><div id="cid_25" class="form-input"> <textarea id="input_25" class="form-textarea" name="q25_input25" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_49"><div class="form-label-left" id="label_49"><label for="input_49"> What can we do to help your child transition into their new classroom? </label><label class="label-message" for="input_49"> </label></div><div id="cid_49" class="form-input"> <textarea id="input_49" class="form-textarea" name="q49_input49" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_26"><div class="form-label-left" id="label_26"><label for="input_26"> Please share anything else that you would like to tell us about your child: </label><label class="label-message" for="input_26"> </label></div><div id="cid_26" class="form-input"> <textarea id="input_26" class="form-textarea" name="q26_input26" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_61"><div class="form-label-left" id="label_61"><label for="input_61"> Do you have any specific goals or expectations for your child? If yes, Please list them.  </label><label class="label-message" for="input_61"> </label></div><div id="cid_61" class="form-input"> <textarea id="input_61" class="form-textarea" name="q61_input61" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_62"><div id="cid_62" class="form-input-wide"> <div id="text_62" class="form-html"><p><span style="font-size:14px;"><strong>Who has permission to pick up your child on a regular basis other than parents?</strong></span></p>
</div> </div></li><li class="form-line" id="id_63"><div class="form-label-left" id="label_63"><label for="input_63"> Who has permission to pick up your child on a regular basis other than parents? </label><label class="label-message" for="input_63"> </label></div><div id="cid_63" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_63" name="q63_input63" size="20" value="" /> </div></li><li class="form-line" id="id_52"><div class="form-label-left" id="label_52"><label for="input_52"> Name </label><label class="label-message" for="input_52"> </label></div><div id="cid_52" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_52" name="q52_input52" size="20" value="" /> </div></li><li class="form-line" id="id_53"><div class="form-label-left" id="label_53"><label for="input_53"> Relationship </label><label class="label-message" for="input_53"> </label></div><div id="cid_53" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_53" name="q53_input53" size="20" value="" /> </div></li><li class="form-line" id="id_54"><div class="form-label-left" id="label_54"><label for="input_54"> Phone Number </label><label class="label-message" for="input_54"> </label></div><div id="cid_54" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_54" name="q54_input54" size="20" value="" /> </div></li><li class="form-line" id="id_55"><div class="form-label-left" id="label_55"><label for="input_55"> Name </label><label class="label-message" for="input_55"> </label></div><div id="cid_55" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_55" name="q55_input55" size="20" value="" /> </div></li><li class="form-line" id="id_60"><div class="form-label-left" id="label_60"><label for="input_60"> Relationship </label><label class="label-message" for="input_60"> </label></div><div id="cid_60" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_60" name="q60_input60" size="20" value="" /> </div></li><li class="form-line" id="id_59"><div class="form-label-left" id="label_59"><label for="input_59"> Phone Number </label><label class="label-message" for="input_59"> </label></div><div id="cid_59" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_59" name="q59_input59" size="20" value="" /> </div></li><li class="form-line" id="id_58"><div class="form-label-left" id="label_58"><label for="input_58"> Name </label><label class="label-message" for="input_58"> </label></div><div id="cid_58" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_58" name="q58_input58" size="20" value="" /> </div></li><li class="form-line" id="id_57"><div class="form-label-left" id="label_57"><label for="input_57"> Relationship </label><label class="label-message" for="input_57"> </label></div><div id="cid_57" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_57" name="q57_input57" size="20" value="" /> </div></li><li class="form-line" id="id_56"><div class="form-label-left" id="label_56"><label for="input_56"> Phone Number </label><label class="label-message" for="input_56"> </label></div><div id="cid_56" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_56" name="q56_input56" size="20" value="" /> </div></li><li class="form-line" id="id_36"><div class="form-label-left" id="label_36"><label for="input_36"> Parents Signature and Date </label><label class="label-message" for="input_36"> </label></div><div id="cid_36" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q36_fullName36[first]" id="first_36" autocomplete="given-name" />  <label class="form-sub-label" for="first_36" id="sublabel_first">Signature</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q36_fullName36[last]" id="last_36" autocomplete="family-name" />  <label class="form-sub-label" for="last_36" id="sublabel_last">Date</label></span> </div></li><li class="form-line" id="id_50"><div id="cid_50" class="form-input-wide"> <div style="text-align: center; text-indent:156px;" class="form-buttons-wrapper button-align-auto"><button id="input_50" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="5652980" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "5652980-5652980";</script></form></div>
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