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Child Intake Form
Please ensure to fill all items with *.
"
*
" indicates required fields
Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
Biological Sex
*
Male
Female
About the child
*
Provide 3-5 sentences (at a minimum) telling us about the child's history and what makes them special.
Profile Picture
*
Accepted file types: jpg, png, jpeg, Max. file size: 512 MB.
Education Records
School
Education Status
*
Active
Inactive
Waiting
Class
*
N/A
Baby Class
Middle Class
Top Class
K1
K2
K3
P1
P2
P3
P4
P5
P6
P7
S1
S2
S3
S4
S5
S6
S7
Inactive Reason for Education Status
Other Life Change
Complete - Primary 7
Complete - Secondary 4
Complete - Secondary 6
Complete - Post-Secondary
Expulsion
Relocation
Current Semester
*
N/A
S1
S2
S3
S4
S5
Current Term
*
N/A
T1
T2
T3
T4
Current Program Year
*
N/A
Year 1
Year 2
Year 3
Year 4
Year 5
Expected Completion Date
MM slash DD slash YYYY
Expected Graduation Date
MM slash DD slash YYYY
Section Break
Ministry Partner
Select Ministry Partner
Central Baptist Church - Wakiso
Develop a Child Africa Ministries (DACAM)
Hope Shine
New Life Missionary
Passion Christian Ministries
Revival Outreach Ministries
Side by Side Ministries
Internal Notes
Child Responses
What makes you smile?
What are your hobbies?
What was your best memory from last year?
What is your favorite food?
What do you want to be in future?
