CHILDREN INFORMATION
CHILD(REN)
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DOCTOR’S INFORMATION
Doctor's Full Name
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DENTIST’S INFORMATION
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PARENT/LEGAL GUARDIANS INFORMATION
Parent 1 Full Name
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Parent 1 Relationship
Parent 1 Phone Number
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Parent 1 Email
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Parent 2 Full Name
Parent 2 Relationship
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Parent 2 Email
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Family Address
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ALTERNATE GUARDIANS INFORMATION
Temp Guardian 1 Full Name (Short Term)
Temp Guardian 1 Address
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Michigan
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Nebraska
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New Jersey
New Mexico
New York
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Ohio
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Utah
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Temp Guardian 1 Phone Number
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Temp Guardian 1 Email
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Temp Guardian 2 Full Name (Short Term)
Temp Guardian 2 Address
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Michigan
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Mississippi
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Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
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State
Zip Code
Temp Guardian 2 Phone Number
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Temp Guardian 2 Email
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Guardian 1 Full Name (Long Term)
Guardian 1 Address
Street Address
Street Address Line 2
City
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Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Guardian 1 Phone Number
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Guardian 1 Email
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Guardian 2 Full Name (Long Term)
Guardian 2 Address
Street Address
Street Address Line 2
City
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California
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Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip Code
Guardian 2 Phone Number
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Guardian 2 Email
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FINANCIAL
Priorities
I consider the following priorities the most important when it comes to the use of the financial resources I have left for my child
Allowance Details
I would like my child to receive an allowance at the following ages and in the following amounts
Vehicle
I would like my Trustee to keep in mind my feelings as follows about providing transportation for my child when she is old enough to drive a vehicle
Financial Education
I would like my guardian to teach my child the value of money in the following ways
Financial Help To Give
The following is a list of items I would expect my child to ask me for money and which I would help her with, if asked
COMMUNITY
Community Involvement
I am involved in the following organizations and activities
Organizations
I would like my child to be introduced to the following organizations and activities that support the community
Charity
I have the following charitable inclinations and would like these to be further developed in my child
VALUES
Values
The personal values that are most important to me and that I would like my child to have a strong understanding of are as follows
RELIGION & SPIRITUALITY
Religion
My child has been raised in the following religion and tradition
Holidays
It is important to me that my child observe the following holidays
Religious Community
It is important to me that my child participate in the following religious community
EDUCATION
School Preference
I strongly prefer that my child attend
Education Values
In selecting and monitoring my child’s educational experiences, it is important to me that the guardian be closely involved in my child’s education by
Extra Curricular
In addition, it is important that my guardian round out my child’s education by providing opportunities outside of the classroom to enjoy like
DISCIPLINE
Discipline
The following methods of discipline are those I use most frequently, and find to be appropriate and effective
PARENTING RESOURCES
Resources
The following resources (books, organizations, etc.) have been helpful to me as I have developed my parenting philosophy. I encourage my child’s guardian(s) to consider these resources for themselves
MISCELLANEOUS INSTRUCTIONS
Other Instructions
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