Central Bible Academy Child Information Form

Please fill out this form and click submit.

Please answer the following questions in order that we may develop the most desirable relationship with your child.

Child's name

Parent's email

This address will receive a confirmation email

Household members (other than parents)

Name & relationship of other adults in the household

Name & age of brothers

Name & age of sisters

Name & kind of pets

Social behavior

What are some of the ways the child plays at home?

Do they play with children from other families? How?

Do they usually get their own way with other children? If not, how do they react?

Is the entire family together for any time during the day?

Does the child treat adults with respect?

Eating habits

Please list what times the child eats breakfast, lunch and dinner

If they refuse to eat, how is this handled and by whom?

Favorite foods

Disliked foods

Food allergens

Toilet Habits

Time at which child is taken to the bathroom

Do they take themselves?

Do they tell you when they need to go to the toilet and go willingly?

Can they manage their clothes themself at the toilet?

What word do they use for urinating?

What word do they use for a bowel movement?

Speech & Physical Growth

Do they talk well?

Please select one option.

Fairly well Not very well Not at all

Does anyone read to them?

Please select one option.

No Sometimes Weekly Daily

At what age did they crawl?

At what age did they walk?

Would you describe them as active or quiet?

How would you describe their weight?

Please select one option.

Thin Average Heavy

How would you describe their height?

Please select one option.

Tall Average Short

Would you describe them as friendly or unfriendly?

Please list other schools and day care facilites your child has attended and a contact person there along with address and phone number.

List any problems such as emotional disturbances, brain damage or congenital conditions.

Agreement

I hereby agree to cooperate fully with Central Bible Academy in helping my child to develop behavior patterns that are a reflection of proper Christian training, so that they may become a useful and productive citizen of this world.

Type name here to serve as signature

Date

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Central Bible Academy Child Information Form

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