Date: ______________

Family Name: ______________________________________  

Child:   Birth Name:  ___________________________
             American Name:
Birthplace (if documented): ________________________
Place of Residence prior to adoption:  _______________________
Giving/Receiving Date: _________________________________

We suggest you write an introductory paragraph thanking the Cambodian government for allowing you to adopt your child and summarizing the current circumstances of your family life.  The following are suggested topics you may want to cover, either in bullet or paragraph format:

1.      Appearance 


2.      Personality 


3.      Daily routine 


4.      Weight, height and percentile: 


5.      Motor Development:  


6.      Speech Development 


7.      Cognitive Development 


8.      Eating Habits: 


9.      Sleeping Habits: 


10.    Health:


11.         Details of Child's Activities (Playing, Schooling, etc.):



(c) 2004