Add or Edit Information



Date Created:  07/18/2019

Assigned Worker:  

Multiple Potential Fathers:  No

Staff Notes:  

Mother's Information

Name:  Braeleigh Paige Kuipers

Nick Name:  Braedi

Date of Birth:  05/14/1997

Address:  956 Meadow Lane, Jenison, Michigan, 49428, United States

Mailing Address:  Michigan, United States

Phone:  616-856-2526

eMail:  Kuipersbraeleigh@gmail.com

Education:  Some College

Employer/School:  

Race:  White or Caucasian

Ethnicity:  American Dutch

Religion:  Strongly Christian Reformed

Hereditary Conditions or Diseases:  No

Hereditary Conditions or Diseases Detail:  

Med/Psych Evaluation:  Yes

Med/Psych Eval Detail:  

Pine rest, 2012- ongoing psychiatric and therapy appointments

Current Health:  Stable, no known problems

Achievements:  [{"Achievement":"2nd degree black belt","Year(s)":"2015"}]

Interests:  

Relationship:  Single Never Married

Spouse/Significant Other's Name:  

Date of Marriage:  

Date of Divorce:  

Currently Pregnant:  No

Due Date:  

Desires Adoption Plan:  No

Prenatal Care:  

Prenatal Care Details:  

Medication and Drug Use:  

Medication and Drug Use Details:  

Other Children:  No

Other Children Details:  

Adoption Plan for These Children:  No

Child's Information

Name:  

Gender:  

Place of Birth:  Michigan, United States

Date of Birth:  

Time of Birth:  

Prenatal Care:  No

Prenatal Care Details:  
(If mother filled out the questionaire before the child's birth, indicate the prenatal care she received after connecting with Greater Hopes.)

Medication and Drug Use:  No

Medication and Drug Use Details:  
(If mother filled out the questionaire before the child's birth, indicate her mication and/or drug use after connecting with Greater Hopes.)

Mother's Health at Birth:  

Father's Health at Birth:  

Child's Health at Birth:  

Medical/Psychological Diagnosis:  No

Medical/Psychological Diagnosis Detals:  

Neglect or Abuse:  No

Neglect or Abuse Details:  

Health Care Provider(s):  

Other Care Providers:  

Custody:  

Cort Order:  No

County of Court Order:  

Court Order Case Number:  

Parenting Time:  

Father's Information

Name:  Ian Frederick Trask

Nick Name:  

Date of Birth:  05/27/1995

Address:  Michigan, United States

Phone:  616-334-5297

eMail:  

Employer/School:  

Education:  Less Than High School

Race:  

White or Caucasian

Ethnicity:  

Amaerican

Religion:  

None

Hereditary Conditions:  Yes

Hereditary Conditions Details:  

Heard disease on mother’s side , diabetes on fathers

Medical/Psychological Diagnosis:  Yes

Medical/Psychological Diagnosis Detals:  

Pine rest 2014

Other Children:  No

Other Children Details:  

Achievements:  

[{“Achievement”:”None”,”Year(s)”:””}]

Interests: