Family to Family Application Family to Family 2022 Family’s information 1. Demographic Information a. Parents Mother Father b. Occupation and profession c. Marital StatusMarriedDivorcedSeparated d. Custody Arrangements SharedMother is a custodian parentFather is a custodian parent e. Home address f. Email(s) g. Contact phone number(s) h. Synagogue affiliation 2. Participating children Child 1 Date of Birth Bar/Bat Mitzvah with the program: YesNo Child 2 Date of Birth Bar/Bat Mitzvah with the program: YesNo Other siblings, names and D.O.B. 3. Psychological Information How would you describe your child? a. Easily Engaged b. Requires time to get to know other children to feel comfortable c. Needs adult support to engage with other children 4. Medical Information a. Does your child have the special medical conditions that we should be aware off? b. Does your child take any prescribed medications? c. Does your child have any allergies including allergies to pets? 5. Hobbies and/or family's interests a. Children's hobbies & interests: b. Activities: c. Pets: d. Any special or specific notes 6. Number of people traveling with the program: M F Ch 7. Bar/bat Mitzvah Information If you’re experiencing problem submitting this form online, you can download it in PDF format