Dhr/cca 8506 - All About Form (Child Care Administration) Page 3

DEPARTMENT OF HUMAN RESOURCES

Child Care Administration

ALL ABOUT: _______________________________________

Child’s First Name or Nickname

Child’s Name: _______________________________________________________ Birthdate: ____________________

Parent/Guardian: ____________________________ Telephone: _____________ Work: _______________________

Address: ___________________________________________________________ Zip: _________________________

Provider/Center: ____________________________________________________ Telephone: ____________________

Address: __________________________________________________________ Zip: __________________________

The information contained herein is for CONFIDENTIAL USE ONLY .

THINGS MY CHILD DOES WELL

WHAT MY CHILD LIKES AND DISLIKES

THINGS I AM WORKING ON WITH MY CHILD

MY CHILD ENJOYS THESE PHYSICAL ACTIVITIES

DHR/CCA 8506 (6/98) Side 1 of 2

Webform – After School Connections Version 3/06/2001 Page 9

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Parent category: Legal