<p> 2014-2015 Breathe Respite Sibling Form</p><p>**Please complete one form for every sibling attending. Child’s Name:______</p><p>Child’s age: ______Child’s Birthday: ______</p><p>Parent’s name: ______</p><p>In order to help our volunteers get to know your child, please tell us about your child’s likes/dislikes.</p><p>If your child has troubling separating from you, do you have any suggestions that would help ease this time? </p><p>Does your child want to be separated from their sibling, spend their evening with sibling and buddy or just check in from time to time? </p><p>We are serving cheese pizza, pretzels, fruit, water and juice during Breathe. Does your child have any food allergies or eating concerns that we need to be aware of. (Note: Breathe is a peanut free event).</p><p>Please include any additional information to help your child have a fun and safe evening.</p><p>Please mail forms to the following BREATHE committee member at least three days prior to BREATHE event:</p><p>Linda Haskenhoff 8851 King’s Orchard Trail Chagrin Falls, OH 44023 OR [email protected] </p>