Child Information Sample Clauses

Child Information. Child’s First Name: Child’s Date of Birth: Date Child Freed for Adoption: Date Adoptive Placement Agreement Signed: Date of Disruption from Previous Adoptive Placement (If Any): Date Child Entered Adoptive Home: Adoptive Parent: Adoptive Parent: Address: City: County:‌‌‌ State: Zip: Phone: ( ) Ext: Name: Address: City: County:‌‌ State: Zip: Case Manager’s Name: Case Manager’s Phone Number: ( ) Ext. Name: Address City: County:‌‌ State: Zip: Case Planner’s Name: Case Planner’s Phone Number:‌ ( ) Ext. Section II‌ Both federal and State law require that payments for an adoption subsidy and non-recurring adoption expenses must be made in accordance with a written agreement. This Agreement will enable the social services district worker and/or the agency worker to determine whether an adoption subsidy and non-recurring adoption expenses will be provided. New York’s Adoption Subsidy and Non-Recurring Adoption Expenses Programs provide subsidy payments to all parents adopting eligible children without regard to the adoptive parent(s) income. However, there are a number of factors that determine the extent and type of benefits that will be provided. These are explained in the Summary of New York’s Adoption Subsidy and Non-Recurring Adoption Expenses Programs that is attached to this Agreement and is incorporated herein (see Appendix A). This Agreement will clearly spell out the benefits to be provided, and identify the provisions affecting those benefits. It will also specify the circumstances under which the benefits may be changed in the future and whether such changes require a new Agreement and State approval or only an amendment to this Agreement. New York State law provides that an application for an adoption subsidy may be accepted before the child is completely freed for adoption, but final approval of the application may not be granted until the child is completely freed for adoption.

Child Information. 2.6.1 Parent(s) must acknowledge receipt of all child information documents provided through MLJ in writing. Parent(s) must accept or reject the referral within a reasonable time after the proposed referral is made. Any rejection of a referred child deemed “unreasonable” by MLJ or governmental or non-governmental organizations in the Child’s country of origin may result in no additional referrals. In this event, the Agreement will terminate automatically. 2.6.2 Parent(s) agree and are responsible to have any and all medical information reviewed by a medical expert of Parent(s) choosing. If possible, this evaluation should take place prior to accepting a referral. Further, Parent(s) agree to provide MLJ with a copy of said evaluation. 2.6.3 If the Child’s country of origin requires that the referral, assignment and/or acceptance of the Child may not occur until Parent(s) travel to the country, Parent(s) must be comfortable with the lack of information provided, 2.6.4 Parent(s) agree not to post any identifying information about the referred child online until the Child arrives home. The purpose of this limitation is to safeguard children and diligently protect the confidentiality of children and the possibility for misuse of a photo or identifying information by individuals or entities online.

Child Information. The following identifying information is provided concerning the child: (a)   (Child’s Legal Name) (b)  - -  (Social Security number) (c)  / /  (Date of Birth) (d)   (Home Address) (e)   (Child's child welfare information system identification number)   (Child welfare system case number) (f) Name and address of child's parent(s), legal guardian, or legal custodian (other than Placing Agency). If parents have different addresses, give the address of the parent with primary legal custody The placing agency has determined that Child Is Is Not eligible for Medicaid on the effective date of this agreement. If eligible for Medicaid, the Child’s Medicaid Number is  

Child Information. Child first name Child middle name Child last name Child name: unknown Date of birth: month, day, and year Date of birth: unknown Date of death: month and day Date of death: unknown Residential address: unknown Residential address: street Residential address: apartment Residential address: city Residential address: county Residential address: zip County of death

Child Information. Parent(s) travel for the purposes of adoption. Parent(s) further understand that this does not signify any fault or negligence of MLJ. 1.7.1 MLJ receives from a Convention or non- Convention country information about the Child that is under consideration for adoption. Depending on the country, MLJ’s international supervised provider or the country’s Central Authority or its designee in a specific country will initially identify a child for adoption and provide the child’s background study. MLJ’s international supervised provider or the country’s Central Authority or its designee in a specific country, will secure the necessary consent or termination of parental rights to adoption. MLJ shall make reasonable efforts to obtain all available medical, psychological and historical records regarding the referred child. MLJ shall provide Parent(s) with copies of the referred child’s medical, developmental, and social records to the extent such records are available to MLJ. 1.7.2 MLJ shall make all reasonable efforts to ensure that such records are translated into English and that Parent(s) receive records in the foreign language and English. In the event that medical records or other reports are provided without translations, Parent(s) shall arrange for their own translations. 1.7.3 The initial report will be provided to Parent(s) adopting from Convention countries at least fourteen (14) days prior to Parent(s) traveling to the Child’s country of origin to finalize the adoption or placement of the Child with Parent(s), whichever is earlier. MLJ does not withdraw a referral until the prospective adoptive parent(s) have had two weeks (unless extenuating circumstances involving the child’s best interests require a more expedited decision) to consider the needs of the child and their ability to meet those needs, and to obtain physician review of medical information and other descriptive information, including videotapes of the child if available. 1.7.4 MLJ shall make all reasonable efforts to obtain information available about the referred child and shall not misrepresent or withhold any such information. However, MLJ cannot guarantee the completeness or the accuracy of the information it receives from any foreign or domestic provider or any governmental entity about the Child. 1.7.5 Nothing in this Agreement shall be construed as creating an obligation by MLJ to conduct any assessment, examination, testing or screening of any child. MLJ will provide such information ...

Child Information. Child’s First Name:   Child’s Date of Birth:   Date Child Freed for Adoption:   Date Adoptive Placement Agreement Signed:   Date of Disruption from Previous Adoptive Placement (If Any):   Date Child Entered Adoptive Home:   Adoptive Parent:   Adoptive Parent:   Address:   City:   County:   State:   Zip:   Phone: (  )   Ext:   Name:   Address:   City:   County:   State:   Zip:   Case Manager’s Name:   Case Manager’s Phone Number: (   )   Ext.   Name:   Address   City:   County:   State:   Zip:   Case Planner’s Name:   Case Planner’s Phone Number: (   )   Ext.  

Child Information. Full Name of Child Full Name Full Name Name Name

Child Information. 1.8.1 MLJ Adoptions receives information about the Child that is under consideration for adoption from the sending country. Depending on the country, an MLJ Adoptions foreign provider, or the country’s Central Authority or its designee will initially identify a child for adoption and provide the Child’s background study. MLJ Adoptions' foreign provider or the country’s Central Authority or its designee, will secure the necessary consent or termination of parental rights to adoption. MLJ Adoptions shall make reasonable efforts to obtain all available medical, psychological, and historical records regarding the referred child. MLJ Adoptions shall provide Parent(s) with copies of the referred child’s medical, developmental, and social records to the extent such records are available to MLJ Adoptions. Nothing in this agreement shall be construed to create an obligation on the part of MLJ Adoptions to conduct any assessment, evaluation, testing, or screening of any child. 1.8.2 The initial report will be provided to Parent(s) adopting from Hague Convention countries at least fourteen

Child Information. List your child’s hobbies or interest List any foods your child likes or dislikes Xxxxx’s sleeping habits: Likes to be rocked Special to in bed Thumb sucking Special blanket Night light Other Does your child enjoy playing with other children or do they prefer playing alone? How does your child react in new situations? Does your child seem reluctant to be left in the care of others? Does your child express fear of: People Darkness Dogs Loud Noises Other What methods of discipline work best with your child? Does your child have angry outburst, temper tantrums, or sullen spells? If yes, how do you handle these situations? Please describe any concerns or expectations regarding your child’s preschool/kindergarten education: Is there any other information you would like to share with your child’s teacher that may be helpful? 1695 N Country Club Rd. Tucson, AZ 85716 ⬩ 000-000-0000 ⬩ xxx.xxxxxxxxxxxxxxxxxx.xxx ⬩ xxxx@xxxxxxxxxxxxxxxxxx.xxx Has your child had previous experience in preschool or daycare? Rolled over both ways Sat up alone Crawled Toilet Training: Started Completed Has your child had the chicken pox: Yes No Does your child have any of the following: Frequent colds Constipation Hay fever Heart Trouble Frequent earaches Severe allergies Diarrhea Nose bleeds Stomach upsets Diabetes Nightmares Asthma If yes to any of the above, please explain frequency and circumstance: Do you feel has behavioral or emotional difficulties? Has your child see a specialist for this issue? Name of specialist or physician Does your child have any speech or language difficulties? Has your child see a specialist for this issue? Name of specialist or physician Does your child have any hearing difficulties: Has your child see a specialist for this issue? Name of specialist or physician Is there any other information your child’s teacher may find helpful to know about your child’s development? Parent/Guardian Name Date 1695 N Country Club Rd. Tucson, AZ 85716 ⬩ 000-000-0000 ⬩ xxx.xxxxxxxxxxxxxxxxxx.xxx ⬩ xxxx@xxxxxxxxxxxxxxxxxx.xxx Health, safety and cleaning procedure, protocols, and regulation are carefully followed in order to maintain the healthiest environment possible for everyone – staff, families, children – at Climbing Tree Community School. Adults and children are required to wear mask on school grounds. I understand and accept the inherent risk of my child/children, staff, and family members being exposed to illness and or contagious diseases while at school. Help keep...

Child Information. I understand that it is my responsibility to inform the Center of any changes to the information on the Emergency Information Form, including but not limited to address, home and work phone numbers, and pick-up authorization and medical conditions.