Child Intake Welcome to the Brittany's Hope Child Sponsorship Intake Form. Please complete all fields below. InformationSubmitter's Name First Last Submitter's Email Child's InformationChild First Name*Child Middle NameChild Last Name/Family Name*Child NicknameGender*MaleFemaleChild DetailsChild Birthdate* MM slash DD slash YYYY Child Photos (Multiple Upload)* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, heic, Max. file size: 10 MB. Description of Child*LocationCenter*House of Love, Viet NamHa Tinh Village, Viet NamBen Tre Orphanage, Viet NamInjibara Children's Home, EthiopiaSt. Mary Magdalene Oasis of Peace, KenyaUkweli Home of Hope, KenyaLitein Community Program, KenyaCommunity, Viet NamIntake Date MM slash DD slash YYYY Arrival Date MM slash DD slash YYYY Enrollment Date MM slash DD slash YYYY Location*House of Love, Viet NamHa Tinh Village, Viet NamBen Tre Orphanage, Viet NamInjibara Children's Home, EthiopiaSt. Mary Magdalene Oasis of Peace, KenyaUkweli Home of Hope, KenyaLitein Community Program, KenyaSiblingsSiblingsDescriptionPlease Describe the Family Situation & Family Background*Clothing SizeShoe SizeFavorite Color*BlackBrownBlueGreenGreyOrangePinkPurpleRedWhiteYellowFavorite Toy*Action FiguresArts & CraftsBaby ToysBikesBooksDollsPuzzlesBoard GamesBuilding BlocksSports EquipmentToy CarsTeddy BearsFavorite Activity*Favorite Hobby*Favorite Animal*Personality Traits*Hold down Crtl to choose more than one.AffectionateAggressiveAnxiousCarelessCheerfulCries EasilyDaydreamsDependentEager to LearnEven TemperedFearfulFollowerFriendlyHappyHelpfulImmatureIndependentLeaderMoodyNervousOutgoingQuietRestlessSadSelf ConfidentSensitiveShares EasilyShyTalkativeUnusually FearlessVery ActiveBehavioral TraitsHold down Crtl to choose more than one.BitingBreaks ObjectsHead BangingHitting/KickingPinchingRefusal to CooperateScratchingStealingTantrumsThrows ThingsYellingHealthHeight (m)*Weight (kg)*Current Health*ExcellentGoodAverageFairPoorCriticalDiseaseMedical Condition (If Any)Reached Puberty? Yes No TreatmentTreatment CenterEducationSchool Type*PublicPrivateBoardingHome SchooledVocationalCollegeGraduatedNoneGrade/Year*Major/Training (If Any)ArtsAccountingAutomotiveBusinessCriminalDentalDivinityElectricalElectronicsEmbroideryEngineeringEnvironmentalFood Processing/ CulinaryHairdressingHotel & Restaurant ManagementHuman ServicesLanguageMedicalMusicSciencesTeachingTechnicalFavorite SubjectArtBiologyChemistryCivic EducationCREComputer StudiesEnglishGeographyHealthHistoryLanguageLiteratureMathMusicPhysical EducationPhysicsPsychologyReadingReligionScienceSocial StudiesSociologySpellingWritingSchool PerformanceExcellentGoodAverageFairPoorWork ExperienceFamilyParents Status*MarriedDivorcedSeparatedNever MarriedWidowedDeceasedUnknownChild's State At Entry to Program Neglected Abused Abuse Type Emotional Physical Sexual Mother's NameMother's StatusDeceasedImpoverishedImprisonedMentally DisabledPhysically DisabledUnemployedUnfitUnknownMother's Location*Mother's Birth YearMother's OccupationMother's HealthExcellentGoodAverageFairPoorCriticalUnknownN/AMother's Medical ConditionMother's Deceased Date MM slash DD slash YYYY Father's NameFather's StatusDeceasedImpoverishedImprisonedMentally DisabledPhysically DisabledUnemployedUnfitUnknownFather's Location*Father's Birth YearFather's OccupationFather's HealthExcellentGoodAverageFairPoorCriticalUnknownN/AFather's Medical ConditionFather's Deceased Date MM slash DD slash YYYY Last Known CaretakerSelfUnknown- AbandonedMotherFatherParentsSisterBrotherGrandmotherGrandfatherGrandparentsAuntUncleCousinStep-MotherStep-FatherGreat AuntGreat UncleNeighborInstitutionFriendUnrelatedCaretaker NameCaretaker AddressCaretaker Phone Δ