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Child Profile Format Final 1

This document contains a child profile form for a child enrolled in the Anugraha Children's Home run by the Living Spring Educational Trust. The multi-page form collects information about the child's family background, living situation prior to enrollment, education status, health, lifestyle habits, family atmosphere and the child's aspirations. It includes sections to collect the child's personal details, photograph, contact information for referrals, religion, caste, disability status, illness history, sleeping arrangements before enrollment and observations about the child.

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3K views3 pages

Child Profile Format Final 1

This document contains a child profile form for a child enrolled in the Anugraha Children's Home run by the Living Spring Educational Trust. The multi-page form collects information about the child's family background, living situation prior to enrollment, education status, health, lifestyle habits, family atmosphere and the child's aspirations. It includes sections to collect the child's personal details, photograph, contact information for referrals, religion, caste, disability status, illness history, sleeping arrangements before enrollment and observations about the child.

Uploaded by

sunil sunny
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Page | 1

LIVING SPRING EDUCATIONAL TRUST


ANUGRAHA CHILDREN’S HOME
Anugraha Children's Home,
No. 33, Achitnagar, 12th Cross,
Near Padamanaba Nagara Layout, Achitnagar Post,
Soladevanahalli, Bangalore - 560107

Child Profile Please paste


passport size
picture here.
Date of Enrolment in : ……../………/20………
Child ID No: …………………………….
Aadhar No: ……………………………………
______________________________________________________________________________
1) Foster Home: …………………………………………………………………………………...
2) Name of the child: ………………………………….. …………………………………
3)Date of Birth: …………………………………4) Age: ……….. 5) Gender: Female/ Male
6) Language:
7a) Height 7b) Weight
8) Identification Marks: …………………………………………..................................................
9) Family profile
Sl. Name Relationship Age Education Marital Occupation Household
No. with Child Completed status Income

10) Contacted /Referred by:


11) Contact person: ……………………………. 9) Contact phone number: ……………………
12)Contact address: ……………………………………………………………………….
………...
………………………………………………………………………………………………………
13) Religion: Hindu/Muslim/Christian/ Sikh/any other (specify) ………………………………..
14) Caste: ………………………………… 14a) Community: SC/ ST/ OBC/ General
Page | 2

15) Education status at enrolment: Studying in formal school/ Excluded/ Studying through
NIOS/Studying in Madrassa/Never Attended School
16)Name of school(studying/studied): ……………………………………………………………
Grade completed/studying: ……………………………………
% of Marks/grade obtained in the last exam …………………………………………

⮚ If a drop-out from formal school or never attended school;

Reason: ……………………………………………………………………………………………..
17) Child staying with?
Relatives / Family (Slum)/ Family (Street) / Friends / Night Shelter/ Railway or bus –Station /
with employer / Alone / Other………………………………………………………………
a) If the child doesn't stay with family, is he/she in touch with family? Yes/No
b) If the child left his/her family; why did the child leave his/her family?
………………………………………………………………………………………………………
c) If the child migrated to Karnataka, details of the native place
Village District State

18) Sleeping place prior to enrolment?


Pavement/ Night shelter/ Worship places/ Parks/ Railway Station/ Bus stand/ Flyover or
Under bridge/ Markets/ Any other (specify)……………………
19) Is the childdifferently abled? Yes/ No
If Yes, a) Type of disability: ……………………………………………………………………….
20) Is he/she suffering from any illness? Yes/ No
Health status of the child : poor, satisfactory, good, very good
Incidence of illness 3 months prior to enrolment? Yes/ No
a) Type of illness: …………………………………………………………………………………..
[Link] Life style
I take bath daily Yes No
I use toilets Yes No
Wash my hands pre & post meals Yes No
Wash my hands after washroom use Yes No
I have three meals a day Yes No
I take part in sports/play Yes No
Page | 3

I do yoga and meditation Yes No

22. Atmosphere in the Family


Quarrels in the family Yes No
Parents Spend time with us Yes No

Domestic violence in the family Yes No

Family members support each other in all works Yes No


Parents encourage us to participate in various social activities Yes No

23. What is the aspiration of the child?


Observations:
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………….

Name &Signature person collected data Date: ………….

(Name and Signature of Programme Manager) (Date)


*******

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