Gan Chabad Health Form

  • General Information

  • Health

  • Emergency Contact Information

  • Mother's Information

  •  Father's Information

  • Emergency Contact

  • Child's Doctor Information

  • If an emergency arises (G-d forbid) and none of the people specified above can be contacted, I hereby give Gan Chabad permission to take any measures deemed proper considering the circumstances.

  • Authorizations for Pick-Up

  • Child will not be release to any individual not in this section unless otherwise indicated in writing by parents/guardian.

  • Parent Assessment

  • In order to provide you and your child with the best experience possible, and to ensure that we meet his/her developmental needs and goals, please complete the following questionnaire and return with forms. This information is confidential, and will be used by the classroom teacher to enhance the curriculum planning and sensitivity to each individual child. Assessing your child’s development during the year is an on-going process, and we encourage your feedback and involvement. Please answer as many questions as you feel comfortable answering.

  • Please assess your child’s developmental progress based on your own perceptions in the following areas:

  • Thank you for sharing your insights with us. It will help us to know your child better. Throughout the year, please be sure to update us on the results of observations from home –so we may better adjust the curriculum and focus.

  • Should be Empty:
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