Portal Public expand_more Public Event Calendar Online Giving Group Finder Opportunity Finder Mission Trip Giving Mission Trip Registration Make A Pledge Find Group by Survey Find Opportunity by Survey Private expand_more Private My User Account My Giving My Purchase History My Contribution Statement My Groups My Events My Mission Trips My Subscriptions My Profile Church Directory My Calls My Pledges Show Summary (0) anonymous Login CV Prep Child Information This form is filled out for each child. *First Name*Last Name*Email Address*Phone Number*Address Line 1Address Line 2*City*State/Province/Region*Zip/Postal Code*Child's Full Name:Name They Would Like To Be Called:*Date of Birth:Child's Nationality:Sex:MaleFemale*Child's T-Shirt Size:12 Months2T3T4T5/6TPrevious school or day care attendance:Describe your child's personality:What goals do you have for your child this year in preschool?:Father's Name:Father's Cell Number:Father's Occupation:Father's Place of Employment:Father's Nationality:Mother's Name:Mother's Cell Number:Mother's Occupation:Mother's Place of Employment:Mother's Nationality:Do both parents have custody of this child?:YesNoIf no, please explain.:Siblings names and ages.:Pets and Pets Names:Does your family attend church?:YesNoIf yes, which church?:If I cannot be reached in an emergency, the following person is authorized to act in my behalf:Name of Person:Relationship to Family:Emergency Contact Phone Number:Many hospitals and doctors will not treat a child without a parent's consent. If we are unable to contact you or your emergency contact person, do you grant permission for CCC to seek emergency treatment?*Consent to Treat?:YesNoName of Doctor:Doctor's Phone Number:Health Insurance Company:Policy Number:Hospital of Choice:List any known allergies your child may have::List anything in your child’s medical history that the teacher should be aware of::List any special needs that may help your child’s teacher better understand your child::Toilet habits: Is your child potty trained? Do they need help?:What terminology does your child use regarding the use of the bathroom?:How does your child react to “accidents?”:Eating habits and difficulties::What foods does your child like?:What foods does your child dislike?:Typical Bedtime:Typical Naptime:How do you get your child to sleep?:Naptime securities (pacifier, bottle, blanket. animal)::Behavior habits (biting nails, sucking fingers, tantrums, biting others, stammering, etc.)::Does your child have any unusual fears? Do you know the cause?:What is your child's reaction to strangers?:Does your child cry easily? If so, why?:Is it easy for your child to be separated from either parent?:What types of discipline are used in the home?:List special interests and toys::*I understand that ClearView Children’s Center is not required to be licensed by the state as a child care agency.:I Understand*Parent Signature*Today's Date: Submit Form