Child Digital Fingerprint Identification Kit

Information Sheet

 

First name:            ____________________

Middle name:           ____________________

Last name:         ____________________

Nickname:         ____________________

Sex:            ______

DOB:          ______              Grade:   ________

Weight:          ______              School:  ___________________

Height:          ______

Eyes:           ______

Hair:           ______

Race:          ______

Disabilities:          ______________________

Blood Type:          ______

Medications:          ________________________________

Allergies:          ________________________________

Social Security #:________________

Vision Correction:      glasses or contacts

Marks/Scars/Birthmarks:          ____________________

Home Address:  _____________________________   

Mother’s name:          __________________________

Father’s name:          __________________________

Phone number:          _____________    Cell number:  _________

Family Doctor:          _____________    Phone#_____________

Family Dentist:          _____________    Phone#_____________

Primary Language:          _____________  Email: ________________

Secondary Language:  _____________

Hobbies/Likes/Dislikes:

_____________________________________________

 

 

*All information provided on this sheet will be confidential and used specifically to complete the Child Digital Fingerprint Identification Kit.  After completion of the kit, this sheet will be returned to the child/parent.