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Summer Miracles® Host Family Report 2010 Week 5

Please complete a separate form for each child that you are hosting.



	Name* First Name Last Name
	Address City State Zip Code
	Phone
	Email
	Summer Miracles Child Full Name: First Name Last Name
	Date Child Entered Your Home:
	7. Child's Current Weight Weight
	Height: Height
	1. Now that you know the child better, please describe his/her personality.
	2. How, if at all, has the child's visit affected your family?
	3. How, in your opinion, has the visit affected the child?


	Please send us any additional photos of you and your child that we might use. Send to Kidsave, 5165 MacArthur Blvd., NW, Washington, DC 20016. Thank you for your help completing these questionnaires. Your generosity in sharing information, your home and your heart is much appreciated.


	A copy of this completed questionnaire will be sent to Kidsave. You will also receive a confirmation copy by return E-mail for your records.