Child’s Profile – Solon Chabad Aftercare Please take a few minutes to answer the following questions. It will help us understand your child better. Child's Full Name First Name Last Name What name would you like to appear on the class lists Does child live with both parents? YesNo If no, please explain living arrangements Please list siblings of the child: Name of Sibling Age Do they live at home? YesNo Name of Sibling Age Do they live at home? YesNo Name of Sibling Age Do they live at home? YesNo Is there a special relationship (other than parents and siblings) that would help us to understand your child better? Does your child have any special food habits? Are there any learning issues, vision, hearing, speech or language problems we should be aware of? Does your child have an IEP in school ? If yes, please explain How do you describe your child’s personality? Please share anything else that you would like to tell us about your child? Do you have any specific goals or expectations for your child? If yes, please list them Who has permission to pick up your child on a regular basis other than parents? Name of person with permission to pick up child First & Last Name Relationship Phone Number Area Code Phone Number Name of person with permission to pick up child First & Last Name Relationship Phone Number Area Code Phone Number Name of person with permission to pick up child First & Last Name Relationship Phone Number Area Code Phone Number Parents Signature and Date Signature Date Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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