About My Child

Please consider the following questions in order to help me learn more about your child. Fill out as much as
you feel necessary and add any other information you feel I should be aware of.
Childs full name: ___________________________________________________________________________________________
Nickname:______________________________________________ DOB: ________________________ Age: _______________
Parent/Guardian names: _____________________________________________________________________________________
Best way to communicate with you: _________________________________________________________________________
Please provide an email address of possible: _________________________________________________________________
What are the after school arrangements for your child? (Eg OHSC, collected by whom, meeting place, walk
home....):____________________________________________________________________________________________________
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Tell me about your childs strengths/talents/hobbies/interests:
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What are your concerns for your child? What is challenging for them?:
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What are your goals? What do you hope your child will gain this year?:
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Allergies/medical issues?: ____________________________________________________________________________________
Who lives in your childs household? (names and relationship to child):
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Anything else you would like to share with me? Please use the back of this page.
Many thanks, Bonnie.