ANNUAL REPORT ON ADOPTED CHILD FROM KAZAKHSTAN
Please fill in, print out, and mail or email. Actual or digital signatures required. Please include 5-8 recent photos of your child with this report. Include a photocopy of any recent school, medical, therapist or psychological reports.
I.
BIOGRAPHICAL INFORMATION
BIOGRAPHICAL INFORMATIONChild's name(s) after adoption:
Child's name(s) before adoption:
Date of birth:
DayMonthYearDate of adoption:
DayMonthYear Child's place of birth:
Adoptive parents name(s) and address:
Phone / Fax /E-mail:
II.MEDICAL INFORMATION
MEDICAL INFORMATIONDate of last medical exam: ______/______/______ (Month/Day/Year)
Height: _________________________
Weight: _________________________
Result of general check-up (major illnesses and hospitalizations):
III.INFORMATION ON CHILD'S DEVELOPMENT
INFORMATION ON CHILD'S DEVELOPMENTPersonality Development:
New Accomplishments / Achievements:
IV.DAILY ROUTINE / LIVING CONDITIONS
DAILY ROUTINE / LIVING CONDITIONSDiet, Eating Habits, Sleep, Napping Patterns:
Likes and Dislikes:
V.ADJUSTMENT TO A NEW ENVIRONMENT
ADJUSTMENT TO A NEW ENVIRONMENTInteraction with Immediate Family:
Acceptance by Extended Family:
VI.ADDITIONAL COMMENTS OR INFORMATION
ADDITIONAL COMMENTS OR INFORMATIONAdoptive father's signature ________________ Date (month/day/year): __/__/2004
Adoptive mother's signature________________ Date (month/day/year): __/__/2004
