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CIT Pre-KIT Registration Form
Please complete one form per child (ages 3-5)
Course Information
Please select course(s):
*
UWM Engage Retreat
Equipping for Cross-Cultural Life & Ministry
Language Learning Accelerator
Debrief
Please select term:
*
SUMMER 1 2024 (June 2-28, 2024)
SUMMER 2 2024 (Aug 11-Sept 6, 2024)
FALL 2024 (Oct 13-Nov 8, 2024)
Please select Debrief term:
*
MAY 12-17, 2024 [NURSERY FULL (Ages 0-1)]
JULY 21-26, 2024 [NURSERY FULL (Age 0-1)]
DECEMBER 8-13, 2024
Child Information
Name of Child
*
Prefix (optional)
First Name
*
Last Name
*
Suffix (optional)
Gender of Child
*
Male
Female
Date of Birth
*
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
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Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Parent Information
Parent's Name
*
Prefix (optional)
First Name
*
Last Name
*
Suffix (optional)
Mother
Prefix (optional)
First Name
Last Name
Suffix (optional)
Debrief Questionnaire
How old was your child when they went to the field for the first time?
*
Has this child been on Home Assignment before?
*
Yes
No
If so, what was the most recent one?
When you arrive at CIT, how long will you have been in the USA? (Days, Weeks, Months)
*
General Questionnaire
Prior to your arrival at CIT, what is the best way for us to contact you if we have a question about your child?
*
Email
Phone
Either
Tell us about your child's daycare/pre-school/kindergarten experiences. (Public/private/homeschool, other?)
*
Does your child struggle with separation anxiety? Please explain.
*
What is your child's bathroom ability?
*
Trained
In Training Process
Does your child have seasonal allergies? Please explain.
*
Is your child on any medication? Please explain and list any medications.
*
Does your child have any dietary restrictions or allergies? Please explain and select severity below.
*
Severity of food restriction/allergy, if applicable
Severely allergic (could cause Anaphylactic shock)
Highly allergic (reaction if in the same room)
Allergic (reaction if eaten)
Restricted for non-allergy reasons
Has your child been diagnosed with or do you have any concerns that your child may have any emotional, mental, or physical challenges?
ADD/ADHD
Anxiety
Asperger's Syndrome
Autism
Depression
Developmental challenges
Dyslexia
Eating disorders
Fetal Alcohol Syndrome (FASD)
Post-traumatic Stress Disorder (PTSD)
Sensory Processing Disorder (SPD)
Special physical needs or challenges
Other
Please explain any selections above
Does your child have any behavioral challenges or problems of which we should be aware? If so, please explain.
*
Is your child adopted? If so, please explain at what age, and any circumstances that would help us as their caregivers.
*
What kind of concerns has your child expressed about coming to CIT and/or moving to another culture?
*
Tell us at least 3 things about your child that would help us know about their personality and what they like.
*
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