Hear The Child Reports

“Family is where life begins and love never ends.”

— Unknown

“Finding a new way to be a family takes time, love, and support, but it’s worth the effort.”

Please complete the following form per Parent/Guardian - per child

Parent/Guardian Name

First Name

Last Name

Name of Child

First Name

Last Name

Child's pronouns

Checkbox

Yes

No

Uncertain

What do I need to know about the Child that will assist the Child to talk to me or help me talk to the Child?

Is the Child allowed a snack during this interview - what would he/she/they like? Any food allergies?

What would help the Child feel comfortable during the interview?

Family pet(s) and name (e.g. Dog, Rover)

Names of close relatives other than Parents (include biological, adopted, and step-siblings)

Names of close family friends the Child may reference?

Names of the Child's close friends?

List the Child's extra-curricular activities (e.g. soccer, dance):

Does the Child have a disability or health issue I should know about (e.g. dyslexia)? If so, please describe:

Are there any cultural considerations the Interviewer should be aware of?

Are there any particular issues you want me to raise with the Child (NB. Please keep issues as generic as possible e.g. Holiday schedule)