Broad Branch Children's House
All About My Child
Child's Name
*
First Name
Last Name
Likes to be called
Please upload one recent photo of your child
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Please upload one family photo
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My child has
blanks
siblings.
Dietary restrictions?
I live with:
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Parent 1 Name (in case of emergency, this is who we call FIRST to pick-up their child) / Child calls parent
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Parent 1 Phone Number
*
Please enter a valid phone number.
Parent 1 works
*
Part-time
Full-time
At home
At work
Hybrid (at home and work)
Travels 25%
Travels 50%
Travels 75%
Other
Parent 2 Name / Child calls parent
*
Parent 2 Phone Number
*
Please enter a valid phone number.
Parent 2 works
*
Part-time
Full-time
At home
At work
Hybrid (at home and work)
Travels 25%
Travels 50%
Travels 75%
Other
Other important family members (name and child calls family member)
Family living arrangement
*
Household parents together
Household sole custody
Household shared custody
If you chose 'household sole custody', please list which parent has custody
If you chose 'household shared custody', please tell us your child's schedule
Is there anything you would like to share about your family living arrangement?
Before coming to Broad Branch Children's House, my child was in the following environment(s):
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Home with family
Home with nanny or au pair
Childcare center
Other Montessori school
Other
How would you describe your child's experience?
Has your child ever received any of the following developmental therapies?
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Speech & Language Therapy
Occupational Therapy
Physical Therapy
None
Other
Is your child currently receiving any of the following developmental therapies?
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Speech & Language Therapy
Occupational Therapy
Physical Therapy
None
Other
Please tell us when your child began to crawl
*
Please tell us when your child began to walk
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Please tell us when your child began to talk
*
Languages spoken at home
*
Please tell us your child's shoe size for our school-provided classroom slippers
*
Please tell us where your child is regarding potty training:
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Incurious
Working on it
Needs occasional assistance
Independent
Other
Comments about potty training?
My child likes
*
My child does not like
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My child may need help with
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Please describe your child's personality
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My child sleeps at
blanks
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. My child wakes up at
blank
.
My child
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sleeps through the night
wakeful
Other
My child naps
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Yes
No
Other
What are you looking for in your child's school experience?
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What do you want your child to become and come away with as a result of his/her school experience?
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What role do you want to play in your child's educational and school community?
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Please tell us the top 5 values of your family:
*
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Permissions Form - Broad Branch Children's House
Broad Branch Children's House will create a directory divided by class that includes parent names, child names, and parent email addresses. Please indicate your choice:
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YES, include me on the BBCH School Directory
NO, exclude me from the BBCH School Directory
The teachers of BBCH enjoy documenting classroom activities through photographs and videos. Please let us know how we may use images and recordings of your child.
*
My child's image may be used ONLY for in-house and password-protected publications (Transparent Classroom, bulletin boards, classroom newsletters, teacher-to-parent emails)
My child's image may be used for in-house and password-protected publications, AS WELL AS Broad Branch Children's House social media, advertisements, and local news stories
*For AfterCare students* Please apply sunscreen to your child each morning before school. PLEASE CHECK HERE to authorize Broad Branch Children's House to administer sunscreen and insect repellent as needed to your child.
*
Yes
No
Any notes/possible side effects with use?
Signature
*
Date
*
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Month
-
Day
Year
Date
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