Other Children Sample Clauses

Other Children. Last First Middle Gender Date of Birth School Grade Non-Medical Special Instructions
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Other Children. Age Gender Grade Speech/Hearing problems? M  F  M  F  M  F  Child’s Primary Language: Guardian’s Primary Language: Does guardian UNDERSTAND English? What are the child’s interests? What does he/she enjoy doing? Birth History Was there anything unusual about the pregnancy or birth?  Yes No If yes, please describe: How old was the mother when the child was born? How many WEEKS GESTATION was the pregnancy? Vaginal or Cesarean delivery? Birth weight: Was the child born premature?  Yes No Was the mother healthy during the pregnancy? _ Did the child need to remain in the hospital after mother was discharged?  Yes  No If yes, explain: Has the child been exposed to any abuse? (substance, emotional, physical) Has your child had any of the following?  Adenoid Removal Date  Ear Infections How often?  Meningitis  Sleeping Difficulties  Allergies  Encephalitis  Mumps Stroke  Breathing Difficulties  Flu  Scarlet Fever Thumb/Finger Sucking  Chicken Pox  Head Injury: Date:  Seizures  Tonsillectomy/Tonsillitis  Colds  High Fevers  Sinusitis  Vision Problems  Attention Deficit Disorder  Auditory Processing Disorder  Pervasive Developmental Disorder  ADD with Hyperactivity  Cerebral Palsy  Sensory Integration Disorder  Autism  Down SyndromeSpecific Learning Disability  Reading, writing, math  Asperger’s Syndrome  Epilepsy  Other  Behavior/Emotional Disorder  Mental Retardation Other serious injury or surgery and date: Has your child been diagnosed with any of the following? Is child currently (or recently) under the care of a physician?  Yes  No If yes, why? List any medications child takes regularly: Please list any precautions, equipment or allergies that may affect your child:  Eyeglasses  Hearing aid  Light or noise sensitivity  Utensils/drinking cups  Food allergy  Helmet  Medical equipment  Wheel chair  Hypersensitivity  Latex allergy  Seating arrangements  Other Please explain if necessary: Describe any pertinent family medical history (mother, father, siblings, grandparents): List approximate AGE child accomplished the following: Crawled: Sat up: Stood: Walked: Fed self: Dressed self: Toilet trained: Used single words: Combined words: Does your child?  Choke on foods or liquids? Brush teeth or allow brushing? Are there certain textures child will not tolerate?  Currently put toys/objects in his/her mouth? Is child a picky eater? Behavior Check ALL behavioral characteristics that your child demonstrat...
Other Children. Clients will not take another child into their home for the purpose of xxxxxx care or adoption during the supervisory period without first obtaining written consent from Agency to do so, which shall not be unreasonably withheld.

Related to Other Children

  • Children For the purposes of the Trust the children of the Grantor are as follows: _______________________________________________________________ ______________________________________________________________________

  • Your Children If your plan includes family coverage, each of your and your spouse’s children are eligible for coverage until the last day of the month in which they turn twenty-six (26). For purposes of determining eligibility for coverage, the term children means: • Natural children; • Step-children; • Legally adopted children; • Xxxxxx children who have been placed with you by an authorized placement agency or court order. A child for whom healthcare coverage is required through a Qualified Medical Child Support Order or other court or administrative order is also eligible for coverage. Your employer is responsible for determining if an order meets the criteria of a Qualified Medical Child Support Order. We may request more information from you to confirm your child’s eligibility. In accordance with R.I. General Law § 27-20-45, when your enrolled unmarried child reaches the maximum dependent age of twenty-six (26), he or she can continue to be considered an eligible dependent only if he or she is determined by us to be a disabled dependent. If you have an unmarried child of any age who is financially dependent upon you and medically determined to have a physical or mental impairment, which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months, that child is an eligible disabled dependent under this agreement. Please contact our Customer Service Department, to obtain the necessary form to verify the child’s disabled status. Periodically you may be asked to submit additional documents to confirm the child’s disabled status.

  • Children/Grandchildren An employee may purchase life insurance in the amount of ten thousand dollars ($10,000) as a package for all eligible children/grandchildren (as defined in Section 2A2 and 2A3 of this Article). For a new employee, child/grandchild coverage requires evidence of insurability if application is made after the initial effective date of coverage as defined in this Article, Section 5C. An employee who becomes eligible for insurance may purchase child/grandchild coverage without evidence of insurability if application is made within thirty (30) days of the initial effective date as defined in this Article. Child/grandchild coverage commences fourteen (14) calendar days after birth.

  • MINOR CHILDREN The Couple recognizes that there are: (check one)

  • Spouse The spouse of an eligible employee (if legally married under Minnesota law). For the purposes of health insurance coverage, if that spouse works full-time for an organization employing more than one hundred (100) people and elects to receive either credits or cash (1) in place of health insurance or health coverage or (2) in addition to a health plan with a seven hundred and fifty dollar ($750) or greater deductible through his/her employing organization, he/she is not eligible to be a covered dependent for the purposes of this Article. If both spouses work for the State or another organization participating in the State's Group Insurance Program, neither spouse may be covered as a dependent by the other, unless one spouse is not eligible for a full Employer Contribution as defined in Section 3A. Effective January 1, 2015 if both spouses work for the State or another organization participating in the State’s Group Insurance Program, a spouse may be covered as a dependent by the other.

  • Family Members Family Members shall mean, as applied to any individual, any parent, spouse, child, spouse of a child, brother or sister of the individual, and each trust created for the benefit of one or more of such Persons and each custodian of a property of one or more such Persons.

  • Death in Immediate Family A regularly scheduled employee may be granted up to five days of leave of absence with pay by the Agency/Department Head because of death in the immediate family. An employee shall be allowed to take such leave within a four week period. For purposes of this subsection, "immediate family" means mother, stepmother, father, stepfather, husband, wife, domestic partner (upon submission of an affidavit as defined in the appendices), son, stepson, daughter, stepdaughter, brother, sister, grandparent, grandchild, xxxxxx parent, xxxxxx child, mother-in-law, and father-in-law, or any other person sharing the relationship of in loco parentis; and, when living in the household of the employee, a brother-in-law, sister-in-law. Entitlement to leave of absence under this subsection shall be only for all hours the employee would have been scheduled to work for those days granted, and shall be in addition to any other entitlement for sick leave, emergency leave, or any other leave.

  • Immediate Family Immediate family includes husband, wife, child, stepchild, brother, brother-in-law, stepbrother, sister, sister-in-law, stepsister, grandmother, grandfather, grandchild, parent, stepparent, mother-in-law, father-in-law, or any person serving as a parent, or who has served as a parent, or any other close person living in the same household as the employee.

  • Pro-Children Act Grantee certifies that it is in compliance with the Pro-Children Act of 2001 in that it prohibits smoking in any portion of its facility used for the provision of health, day care, early childhood development services, education or library services to children under the age of eighteen (18), which services are supported by federal or state government assistance (except such portions of the facilities which are used for inpatient substance abuse treatment) (20 USC 7181-7184).

  • Immediate family or household (1) The entitlement to use carer’s leave and compassionate leave in accordance with this clause is subject to the person being either: (a) a member of the employee’s immediate family; or (b) a member of the employee’s household.

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