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Weekend Miracles Host Family Initial Weekend Report

Please complete a separate form for each Weekend Miracles child that you are hosting.
Family Full Name:
Mailing Address:
Phone:
Your E-mail:
Are you a single parent or a couple? Single Couple
Number of other children in the family not counting the Weekend Miracles Child.
Weekend Miracles Child Name:
Child's Birth Date:
Child's Sex: Male Female
Name of Child's Foster Parents:
Date Child Entered Your Home:
1.  What made you decide to host in this program? How did you learn about the Weekend Miracles Program?
2. Please describe your first reaction when you saw the child:
About the Child:
3. Describe how the child's personality has emerged over the visit.
4. Describe how the child's response to members of the family is going.  Is the child able to engage and relate? Does the child seem more comfortable with certain people in the family? How does the child react around strangers?
5. Describe how the child is adjusting in your home. Are there people to whom the child has warmed? Are there people the child seems to avoid or be more reluctant to be around? Has the child's demeanor changed?
6. How does the child act or relate to adults? Is the child respectful, comfortable, cooperative, and accepting of adult authority?
7. How does the child relate to other children?
8. Please describe your perception of the emotional state of the child. Does the child seem homesick, depressed, happy, etc.?
9. What foods has the child enjoyed that have agreed with him/her? Are there foods that made him/her sick? 
10. What does the child like (activities, interaction, routines)?
11. What frightens the child?
12. What concerns you about the child?
13. What do you like about the child?
14. What kinds of problems have you had with the child?
15. What information could have helped you manage these problems?
16. Are the any medical or psychological problems that need to be addressed with this child to help you?
17. Are there any concerns about this child you would like to discuss? Kidsave Representative
Social Worker
Best Time of Day to Reach You?
A copy of this completed report will be sent to Kidsave.   You will also receive a confirmation copy by return E-mail for your records.
(Click submit to send.)

 


 
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