Hand in Hand All About Me Form

Hand in Hand
3860 Middle Road
Bettendorf, Iowa 52722
email us: info@handinhandqc.org

Phone: (563) 332-8010 Fax: (563) 332-7396

All About Me (Please fill out as completely as possible.)

My name is:*

My phone number is:*

My mother or fathers name is:*

My parents email is:*

My birthday is:

I am years old

I am diagnosed with:

I am allergic to:

I communicate by:

I live with:

Activities I enjoy:

Activities I dislike:

Things I do to relax:

I am afraid of:

My favorite foods are:

I prefer not to eat:

What makes me unique:

Special considerations when caring for me:

* - Mandatory Fields.

Hand-in-Hand is a non-profit organization that assists families with special needs. We exist to expand the capabilities, confidence and quality of life for children and young adults of all abilities by providing programs designed to encourage fun, learning and social interaction in a positive environment.