Family Information Sheet printable pdf download

Family Information Sheet

2017-2018

Child’s Name ______________________________________Male___Female___Nickname_______________

First

Middle

Last

Home Address_____________________________________________________________________________

Child lives with ________________________________Pets ________________________________________

Is your child a morning person or night owl? _______________ Primary language?______________________

Favorite Toy(s) ______________________________ Favorite Book(s)_______________________________

Favorite Song(s) _______________________________ Other_______________________________________

Any specific fears? _________________________________________________________________________

What comforts your child when sad or afraid? ___________________________________________________

Travel experiences ________________________________ Family interests___________________________

What you would like us to work on with your child?_______________________________________________

What are your child’s strengths, talents, & weaknesses?____________________________________________

_________________________________________________________________________________________

Father’s Information

Mother’s Information

______________________________________________

____________________________________________________

First Name

Middle

Last Name

First Name

Middle

Last Name

Home Address (If different from student)

__________________________________________

____________________________________________

Home phone _______________________________

Home phone _________________________________

Father’s cell phone __________________________

Mother’s cell phone ___________________________

Business/Employer __________________________

Business/Employer ____________________________

Business phone/Ext __________________________

Business phone/Ext____________________________

Email _____________________________________

Email_______________________________________

Other children in the family:

Name _______________________________ Present Age & School__________________________________

Family Information Sheet