| Member: David Johnson |
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Member Since
2005-04-15 |
Emergency Contact
David: (555) 555-5555 (father) Susan: (555) 555 5555 (mother) |
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Address
123 Safety Street Anywhere, California 55555 |
Phone Number(s)
(555) 555-5555 |
Email
childsafety@playdatesecure.com |
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Child Safety Class
Yes. Child CPR class attended at our local police department February 2005 |
CPR Training
Yes. |
Seat Belts
Yes, seat belt use is mandatory in our vehicle(s). |
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Smoking
No, I we/don't smoke. No, I/we don't smoke around children. |
Drinking/Alcohol
Yes, I/we drink alcohol. No, I/we don't drink alcohol around children. Yes, there is alcohol in our home and its secured. |
Firearms
Yes, I/we keep fire-arms in our home. Yes, I/we have 1 or more pistols. No, I/we don't have any rifles. We secure all firearms in a state of the art safe that is always locked and secured safely away from child access |
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Pool
Yes, I/we have a pool. Our pool is completely fenced and locked off. We supervise our children when they are playing in the pool. |
Body of Water
No, I/we don't live near a body of water. |
Pets
None. |
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Stairs
Yes, our home has stairs. Our son is 6 and we feel no need to secure stairways at this point |
Medications
Safely secured in a container out of children's reach |
Household Chemicals
Locked in a cabinet with child safety lock |
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Garage
No, our garage is not accessible. |
Knives, scissors, etc.
Yes, knives, scissors etc. are secured. |
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Additional Information
We feel that every precaution should be made in order to ensure the safest environment for our children and the children who play at our home. |
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Child
Matthew Johnson |
Boy/Girl
Boy |
Age
6 |
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Allergy Concerns
Matthew has an allergic reaction to WALNUTS. |
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Likes
White cheese macaroni, chicken nuggets, edamame soy beans, egg whites, and of course all junk food (not that we allow him to over indulge however) Playing with friends, searching for bugs and animals, playing playstation 2 wrestling, golf |
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Dislikes
Anything with tomatoe sauce and most vegtables of course Matthew does not like swimming. |
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Video Games
This child is allowed to play video games rated: E. Games console(s): Play StationGame(s): ATV, Fairly odd parents, Sponge bob, Spiderman, Tiger woods Golf, various car racing games. |
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Movies/Videos
This child is allowed to watch rated: G movies. Movie(s): Ice age, Shrek, The incredibles, Fairly odd parents |
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BB Gun or Other Firearms?
No. |
Jet Ski?
No |
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Motorcycle?
No |
Go-kart?
No |
ATV?
No |
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Additional Information
Matthew is a fun loving young boy who loves to play with his friends. He is very polite and outgoing. |
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