U.S. Weekend Miracles

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Weekend Miracles Host Family Follow Up Weekend Report


Please complete a separate form for each Weekend Miracles child that you are hosting.
Family or Mentor Full Name:
Mailing Address:

Phone:
Your E-mail:
Weekend Miracles Child Name:
Date(s) of Visit(s) in Your Home:
Time Spent:

1. What did you and your host child do together?


2. Did you host child seem to enjoy/participate/engage in the activity?

3. How do you think the visit went?


4. How did the child respond to you?


5. Did you learn anything new or special about your child this week?


6. How did your host child respond to your family members?


7. Were there any difficulties with your host child and other family members?


8. Do you have any concerns regarding your host child's behavior or attitude during the visit?


9. Do you have any unmet needs or need for support?


10. Are there any concerns you would like to discuss with the social worker?


11. If you would like to discuss your concerns, what is the best time to reach you? Please provide contact information and your preferences (E-mail , telephone, etc.).


12. Are you involved in any planned interventions or activities on behalf of your child? ( i.e. behavior plan, IEP) What was the outcome this week?


13. What advocacy efforts have you engaged in for this week?


14. Is there someone you would like staff to contact on the child's behalf? If so, please provide name(s) and contact information.


A copy of this completed Follow Up Weekend 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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Weekend Miracles Host Family Follow Up Weekend Report

Please complete a separate form for each Weekend Miracles child that you are hosting.