Age: 10 Sex: M Date of Birth: 10/28/2000
Height: 4 Feet 3 Inches Weight: 60 Pounds Hair Color: Brown Eye Color: Brown
2. Attends School: Yes
3. Favorite School Subjects: Art
Favorite Pastimes: Playing soccer, Listening to music, Playing with friends
Chores at Home: Running errands, Sweeping
Talents or Hobbies: Dancing, Drawing, Singing
Languages Spoken: Spanish
INFORMATION ABOUT YOUR CHILD'S FAMILY:
4. Approximate monthly income for the family (in U.S. Dollars): $125.00
5. Name of Father: Deiver Occupation: Baker
(If not present, why?)
6. Name of Mother: Amalfi Occupation: Homemaker
(If not present, why?)
7. Brothers and Sisters:
Name: Esneiver Manuel Age: 7 Sex: M
8. Child lives with: Parents
INFORMATION ABOUT YOUR CHILD'S HOME:
9. Description of Home: Kitchen, Bathroom, One multi-use room
Construction: Walls: Concrete block Roof: Corrugated metal Floor: Concrete
Cooking Facilities: Portable gas stove
Sleeping Accommodations: Wooden beds
10. Facilities and Services:
Water Source: Running water in home
Electricity: Non-regulated usage
Sanitary Facility: Toilet
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