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ECC Family Personal History Form
Please verify reCaptcha before submitting the form.
Child's First and Last Name
Parent 1 First Name
Parent 1 Last Name
Parent 2 First Name
Parent 2 Last Name
Your Family: Please check one item below
Married
Separated
Divorced
Widowed
Remarried
Single Parent
Who has legal custody of your child?
Please list all other residents of the household (relatives, boarders, household staff, etc.)
Name:
Relationship
Name
Relationship
Name
Relationship
How long has your family resided in Los Angeles?
Where did you reside previously?
How long?
Parent 1's Present Occupation
Parent 2's Present Occupation
Other languages spoken in family and by whom:
Religious Background of Family
Parent 1:
Jewish
Non-Jewish
Parent 2:
Jewish
Non-Jewish
Child's History:
Please list all allergies (ex: nuts, bee stings, penicillin)
Walked at (months):
Began to talk at:
Special words for toilet:
Does your child take a pacifier at home?
Does your child take a bottle at home?
Does your child have a particular blanket or toy as a transitional object?
Describe any illness, accidents, hospitalization, etc. that your child has experienced:
Has your child had previous group experiences? Please describe:
How does your child handle new situations?
What helps comfort your child when troubled or frustrated?
What activities does your child most enjoy sharing with Parent 1?
What activities does your child most enjoy sharing with Parent 2?
What activities does your child most enjoy sharing with siblings?
Please describe something about your child's personality that will help us better understand him/her:
What is your hope/goal for your child in the coming year?
Do you have any suggestions or comments for the teachers or school?
Tue, April 23 2024
15 Nisan 5784
Today's Calendar
Passover
Upcoming Programs & Events
Apr
24
Women's Seder 2024
Wednesday, Apr 24 6:00pm
Apr
25
We, the Storytellers, taught by Rabbi Scott Goldberg
Thursday, Apr 25 12:00pm
Apr
30
LBT Men presents: "Holy Cow!" A Men's BBQ Seder
Tuesday, Apr 30 6:30pm
May
10
Religious School Family Shabbat and Teacher Appreciation Dinner May 10
Friday, May 10 6:15pm
May
17
Bubble Up Celebration pre-Shabbat Dinner: Honoring Facilitators, Organizers, and ALL Participants!
Friday, May 17 6:15pm
View Calendar
Tue, April 23 2024 15 Nisan 5784
