Wufoo
Hosting Week 4
Your Name
First
Last
Child's Name
First
Last
Child's Sex
Male
Female
Child's Date of Birth
/
MM
/
DD
YYYY
How would you describe the child's personality?
What has changed about your description of the child from previous descriptions?
Has your child discovered any new activities he/she likes?
Please describe some of your favorite memories with your child.
Please describe the emotional state of the child.
How, if at all, has the child's visit affected your family?
Have you had any new or different problems with the child?
What has helped you manage these problems?
Child’s current weight:
Has your child found a forever family?
Yes
No
Undecided
If your child has not found a forever family, please write a biography that we can distribute to other families that may be interested in getting to know him/her. We always have families asking about children that have not been spoken for.
Are there any concerns about this child you would like to discuss with a New Horizons for Children hosting representative?
If so, phone number and the best time of day to reach you?
Please Upload 2 Photos of your child
Do Not Fill This Out
