Inquirer Information Form - Child\Teen

"*" indicates required fields

Child/Teen Inquirer Information Form

Information is held in confidence and is not shared without your permission.
Child/Teen's Name*
Date of Birth*

I. Parent/Guardian Information

List Below the name(s) of parent(s)/guardian(s) and present religious affiliation, if any:
Full Mailing Address
Child/Teen lives with:*
If there is a joint custody arrangement, please provide alternate full address:

II. RELIGIOUS HISTORY

1. Has your child/teen ever been baptized?
2. If your child/teen was baptized as a Catholic, check those sacraments he/she has received
For a teen: Has he/she been married or is he/she currently married?

If you answered “Yes” to Question 1, please provide the following information:
(include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)

IV. FAMILY INFORMATION

List the name(s) of any siblings (e.g., John — Brother; Jean — Stepsister)

V. LEARNING STYLE

Not all people learn in the same way. You can help your child/teen get as much out of this process as possible by sharing about your child’s learning abilities.
For example: “Mary is very outgoing and gets excited when she is having fun. She becomes quiet when she doesn’t understand something. She works well with other children. Mary also has a 30% hearing loss in her left ear. She may not hear you if you are standing behind her and speaking normally.”

VI. GENERAL QUESTIONS