Confidential Student Profile

Please give the following questions your careful attention so we have all the necessary information we need to ensure the success of all students individually and as part of a group.

Personal information is shared only with the J Kids All Day administrators and your child's group counselors.

All staff guard and respect the sensitive nature of this information.

Participant Name Participant Name First Last
Home Life
With whom does your child live with? (i.e.: mother only, father only, both parents, stepparents, siblings, step-siblings, etc). Please make note if your child spends time in two or more homes.
My child's relationship with his/her siblings/step-siblings is:
Please explain:
A Jewish Child Care Program For All Families

As a Jewish Child Care program, we will provide exposure to a variety of Jewish cultural & religious experiences throughout the program. For students who are part of families participating in Jewish life, this will mean a strengthened Jewish identity. For our non-Jewish students, this will mean exposure to Judaism in a diverse and welcoming environment.
With this in mind, is there any information regarding religious observance or background of your family you would like us to know?
Behavior

We work hard to ensure every day is a great day in our program. We also want to help children grow and become better at managing their day.

The answers to these questions will allow us to help them when they need it.
Is your child presently (or in the past 6 months) engaged in treatment or counseling?
If you selected "yes" to the question above please share with us as much as you can. If you selected "no" you can leave this box blank.
When your child is engaging socially with peers, are the interactions generally:
What can we do to help?
When your child is upset/and or sad what helps them feel better? Check all that apply.

When your child is upset/and or sad what helps them feel better? Check all that apply. Time and space to bounce back on their own Distraction Love and attention Other
Please Explain:
If/When your child displays a difficult behavior, what does that look like? Please select all that apply

If/When your child displays a difficult behavior, what does that look like? Please select all that apply Inappropriate Language Leaving the Group Without Permission Throws Objects Physically Tries to Injure Others None Apply Other Other
Have you noticed anything that triggers your child to exhibit the above behavior(s)?
Has your child expressed concerns about attending our school program?
Child Care Questions
Does your child enjoy being in a learning environment? Please explain.
What is your child's favorite subject in school?
What is your child's least favorite subject in school?
Has your child struggled with virtual learning? If so, what can we do to help?

Confidential Student Profile

Confidential Student Profile

Home Life

A Jewish Child Care Program For All Families

Behavior

Child Care Questions