PERSONAL SELF HELP MANUAL "The investment you make in yourself today will determine the quality of your life in the days and years to come." Author Unknown OWNER: ____________________________________________________ IMPORTANT DISCLAIMER: Before starting any health / fitness / wellness program, all individuals should consult with their physician or primary health care provider. All information, provided by the publisher, in this handbook is of general nature for your own personal use. No material in this handbook is to be taken as medical, health, wellness or fitness advice. This material is not a treatment plan, a recommendation, or a course of action for any individual. The publisher and / or it’s associates are not liable or responsible, in whole or in part, to any person, or entity for any injury, or damage, or loss of any sort, caused or alleged to be caused directly or indirectly by the use, practice or dissemination of any of the techniques, information, or ideas presented in this handbook. It remains your responsibility to evaluate the complete usefulness of the handbook. Some information on various charts are referenced to their credited sources.
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PERSONAL SELF HELP MANUAL
"The investment you make in yourself today will determine the quality of your life in the days and years to come." Author Unknown OWNER: ____________________________________________________ IMPORTANT DISCLAIMER: Before starting any health / fitness / wellness program, all individuals should consult with their physician or primary health care provider. All information, provided by the publisher, in this handbook is of general nature for your own personal use. No material in this handbook is to be taken as medical, health, wellness or fitness advice. This material is not a treatment plan, a recommendation, or a course of action for any individual. The publisher and / or it’s associates are not liable or responsible, in whole or in part, to any person, or entity for any injury, or damage, or loss of any sort, caused or alleged to be caused directly or indirectly by the use, practice or dissemination of any of the techniques, information, or ideas presented in this handbook. It remains your responsibility to evaluate the complete usefulness of the handbook. Some information on various charts are referenced to their credited sources.
Personal Self Help Manual E-book
INDEX Section Topics General Section Chart # Page # 1. Confidentiality Form – 8 2. 2008 Annual Calendar Form – 9 3. Blank Monthly Calendar Form – 10 4. Blank Daily Calendar Form – 11 5. Blank Weekly Calendar Form – 12 6. Dates to Remember Form – 13 7. Weights and Measures Form – 14 8. Websites, User Names etc. Form – 15 9. Meal Planner Form – 16 10. Full Day Meal Planner Form – 17 11. Table Seating Plan Form – 18 12. Movie List Form – 19 13. Birthstone Gift Form – 20 14. Laundry Labels Sheet #1 – 21 15. Laundry Labels Sheet #2– 22 16. Laundry Labels Sheet #3 – 23 17. Daily Food Guide– General Section - 24 18. Recipe Index– 25 19. Recipe Blank Cards – 26 20. Recipe Blank Cards Sheet 2 – 27 21. Recipe Blank Sheet 3 – 28 22. Statutory Holiday Planner– 29 23. Pet Record Chart– 30 24. Pet Dedication– 31 25. Pet Stories & Pictures– 32 26. Pet Memories & Pictures– 33 27. Christmas Holiday Plan – 34 28. Christmas Budget – 35 29. Christmas Card List - 36 30. Christmas Gift Shopping - 37
Health Section 31. Medical Alerts Form – 39 32. Medical History Form – 40 33. Medication Form – 41 34. Daily Health Form – 42 35. Daily Health Sheet 2 Form – 43 36. Blood Pressure Record Form – 44 37. Medical Tests Record Form – 45 38. Medical Health Contacts Form – 46 39. Food Diary Form – 47 40. Men & Woman Weight & Height Chart – 48 41. Metric Weights Men & Woman– 49 42. Calories in Alcohol Drink – 50 43. Child’s Health Record– 51 Fitness Section 44. Exercise Schedule Form – 53 45. Daily Fitness Chart – 54 46. Daily Fitness Chart – 55 47. Daily Total Progress Chart – 56 48. Monthly Total Progress Chart – 57 49. Annual Personal Progress Chart – 58 50. Food Energy Counts Chart – 59 51. Fitness Contacts – 60 52. Body Mass Index Chart – 61 53. Activity Fitness Chart – 62 54. Calories Burnt During Activities Chart – 63 55. Record Child’s Growth Chart – 64 Wellness Section
56. Gratitude Exercise Info – 66 57. Gratitude Exercise Form – 67 58. My Goals Form – 68 59. Make Changes Form – 69 60. Decisions Pros & Cons Form – 70 61. Balanced Lifestyle Plan Form – 71 62. Achievement, Successes Form – 72 63. Areas for Improvement Form – 73 64. Wellness Contacts – 74 65. Daily / Weekly Diary– 75 66. Problem Solver– 76
Financial Section 67. Finances Checklist Form – 78 68. Monthly Payments Form– 79 69. Record of Bill Payments Form– 80 70. Quarterly, Semi/Annual Expenses Form– 81 71. Basic Monthly Expenses Form– 82 72. Basic Semi/Annual Expenses Form– 83 73. Financial Contacts Form– 84 74. Bank Reconciliation Form Sheet #1– 85 75. Bank Reconciliation Form Sheet #2– 86 76. House & Mortgage Information – 87 Organization Section 77. Confidential Information Checklist Form – 89 78. Event Planner Form – 90 79. Grocery Shopping Form – 91 80. Things to Do Form – 92 81. Detailed Contact Information – 93 82. Family, Friends & Co-Worker Gift List – 94 83. Daily Organizer – 95 84. Personal Property Inventory Sheet 1– 96 85. Personal Property Inventory Sheet 2– 97 86. Personal Property Inventory Sheet 3– 98 87. Personal Property Inventory Sheet 4 - 99 88. Shopping Websites – 100 89. Contact Information – 101 Family Section 90. Fire Home Escape Form – 103 91. Our Family Chart – 104 92. Family Birthday Chart – 105 93. Family Weekly Schedule Chart – 106 94. Company/Guests/Visitors Chart – 107 95. Personal Contacts – 108 96. Family Traditions – 109 97. Positive Reward System Chart – 110 98. ‘Find It Treasure” Cutout Cards – 111 99. Family Tree Sheet 1– 112 100. Family Tree Sheet 2– 113 101. Family Tree Sheet 3– 114
102. Family Tree Sheet 4– 115 103. Family Tree Beginning– 116 104. Family Tree Index– 117 105. Family Tree (Grand) Children– 118 106. Family Tree Siblings/Nieces-Nephew– 119 107. School Days Book Cover– 120 108. School Days Index– 121 109. School Days Grades K-13-122 110. School Days Awards/Achievements– 123
Travel Section 111. Travel Itinerary Form – 125 112. Items to Pack Form – 126 113. Reminders Form – 127 114. Places I have Visited Form – 128 115. Daily Vacation Itinerary Form – 129 116. Travel Contacts – 130 117. Vacation Budget – 131 118. Vacation Scheduler – 132 119. Vehicle Log – 133 Journaling Section 120. Journaling Form - 135
PERSONAL SELF HELP MANUAL - SECTIONS
PAGE # SECTION TOPIC
GENERAL SECTION
TABLE OF CONTENTS
PAGE # TOPIC / DESCRIPTION / TITLE
THIS
PERSONAL SELF HELP MANUAL
BELONGS TO:
Enter your name here:_________________________________________________________________ Your personal health is very private and confidential. You may wish to have certain loved ones, friends or Health Care Providers have reference to the information that you have recorded into your manual. Here is a section for you to list person (s) whom you permit to have access to the contents in your manual. Enter a list of person(s) whom you permit to have access to your manual:
PUBLIC HOLIDAYS ANNUAL NOTES New Year's Day Jan. 1 ___________________________________ Family Day Feb. 18 Good Friday March 21 ___________________________________ Easter Sunday March 23 Victoria Day May 19 ___________________________________ Canada Day July 1 Labour Day Sept. 1 ___________________________________ Thanksgiving Day Oct. 13 Remembrance Day Nov. 11 ___________________________________ Christmas Dec. 25 Boxing Day Dec. 26 ___________________________________
MONTHLY CALENDAR:_____________________________
SUN MON TUE WED THUR FRI SAT
NOTES:
DAILY CALENDAR:_____________________________
Time Task
WEEKLY CALENDAR:_____________________________ DAY TIME
DATES TO REMEMBER
DATE EVENT TO REMEMBER
WEIGHTS & MEASURES
Volume Conversions Imperial Metric
1/4 teaspoon (tsp) 1.25 ml (milliliter) 1/2 tsp 2.5 ml 1 tsp 5 ml 1 tablespoon (tbsp) 15 ml 1/4 cup 60 ml
1/3 cup 75 ml 1/2 cup 125 ml 2/3 cup 150 ml 3/4 cup 175 ml 1 cup 250 ml 1 1/8 cups 275 ml 1 1/4 cups 300 ml
1 1/2 cups 350 ml 1 2/3 cups 400 ml 1 3/4 cups 450 ml 2 cups 500 ml 2 1/2 cups 600 ml 3 cups 750 ml 3 2/3 cups 900 ml 4 cups 1 liter
1/2 ounce (oz) 15 g (grams)1/4 in (inch) 5 mm (millimeter)
1 oz 25 g 1/2 in 1 cm (centimeter) 2 oz 50 g 1 in 2.5 cm
3 oz 75 g 2 in 5 cm 4 oz 100 g 3 in 7 cm 6 oz 175 g 4 in 10 cm 7 oz 200 g 5 in 12 cm 8 oz 250 g 6 in 15 cm 9 oz 275 g 7 in 18 cm 10 oz 300 g 8 in 20 cm 12 oz 350 g 9 in 23 cm 1 lb (pound) 500 g 10 in 25 cm 1 1/2 750 g 11 in 28 cm
PLAN GUEST SEATING ARRANGEMENTS ON TABLE OF CHOICE BELOW
MOVIE LIST- GENERAL
DATE MOVIES VIEWED MOVIES TO WATCH LIST
GIFT REFERENCE GENERAL MONTH ZODIAC SIGN BIRTHSTONE FLOWER January Capricorn * Dec 22 – Jan 20 Garnet Carnation/Snowdrop
February Aquarius *Jan 21 – Feb 18 Amethyst Violet/Primrose March Pisces * Feb 19 – Mar 20 Aquamarine Jonquil/Daffodil April Aries *Mar 21 – Apr 20 Diamond Sweet Pea/Daisy
May Taurus * Apr 21 – May 21 Emerald Lily/Hawthorne June Gemini * May 22 – Jun 21 Pearl Rose/Honeysuckle July Cancer * Jun 22 – Jul 22 Ruby Larkspur/Water Lily
August Leo *Jul 23 – Aug 23 Peridot Poppy/Gladiolus September Virgo * Aug 24 – Sep 22 Sapphire Aster/Morning Glory October Libra *Sep 23 – Oct 23 Opal Calendula/Cosmos
November Scorpio * Oct 24 – Nov 22 Topaz Chrysanthemum December Sagittarius *Nov 23 – Dec 21 Turquoise Narcissus/Holly ANNIVERSARY TRADITIONAL MODERN First Paper Clocks Second Cotton China Third Leather/Muslin Crystal/Glass Fourth Silk/Fruit/Flowers Electrical Fifth Wood Silverware Sixth Iron Wood Seventh Copper/Wool Desk Set Eighth Bronze Linen/Lace Ninth Pottery/China Leather Tenth Tin/Aluminum Diamond Eleventh Steel Fashion Jewelry Twelfth Linen/Silk Pearls/Gems Thirteenth Lace Fur/Fabrics Fourteenth Ivory Gold Jewelry Fifteenth Crystal Watches Twentieth China Platinum Twenty-Fifth Silver Silver Thirtieth Pearl Diamond Thirty-Fifth Coral/Jade Jade Fortieth Ruby Ruby Forty-Fifth Sapphire Sapphire Fiftieth Gold Gold Fifty-Fifth Emerald Emerald Sixtieth Diamond Diamond
LAUNDRY LABELS SHEET 1 - GENERAL NOTE: SYSTEM OF DOTS INDICATES TEMPERATURE RANGE FOR ALL WASH PROCEDURES.
WASH SYMBOL
CARE INSTRUCTIONS INSTRUCTIONS AS FOLLOWS…..
Machine Wash, Normal Garment to be laundered through the use of hottest available water, detergent or
soap, agitation, and a machine designed for this purpose.
Machine Wash, Cold Initial water temperature should not exceed 30C or 65 to 85F.
Machine Wash, Warm Initial water temperature should not exceed 40C or 105F.
Machine Wash, Hot Initial water temperature should not exceed 50C or 120F.
Machine Wash, Hot Initial water temperature should not exceed 60C or 140F.
Machine Wash, Hot Initial water temperature should not exceed 70C or 160F.
Machine Wash, Hot Initial water temperature should not exceed 95C or 200F.
Machine Wash, Permanent Press
Garment can be machine laundered only on the setting designed to preserve Permanent Press with cool down or cold rinse prior to reduced spin.
Machine Wash, Gentle or Delicate
Garment can be machine laundered only on the setting designed for gentle agitation and/or reduced time for delicate items.
Hand Wash Garment can be laundered through the use of water, detergent or soap and gentle hand manipulation.
Do Not Wash Garment can not be safely laundered by any process. Seek Dry Clean instructions.
NOTE: All (98+%) washable textiles are safe in some type of bleach. IF BLEACH IS NOT MENTIONED OR REPRESENTED BY A SYMBOL, ANY BLEACH MAY BE USED.
BLEACH SYMBOL
CARE INSTRUCTIONS INSTRUCTIONS AS FOLLOWS…..
Bleach When Needed Any commercially available bleach product can be used in the laundering process.
Non-Chlorine Bleach When Needed
Only a non-chlorine, color-safe bleach may be used in the laundering process. Chlorine bleach can not be used.
Do Not Bleach No bleach product can be used. The garment is not colorfast or structurally able to withstand any bleach.
LAUNDRY LABELS SHEET 2 - GENERAL NOTE: SYSTEM OF DOTS INDICATING TEMPERATURE RANGE IS THE SAME FOR ALL DRY PROCEDURES.
DRY SYMBOL CARE INSTRUCTIONS INSTRUCTIONS AS FOLLOWS…..
Tumble Dry, Normal A machine dryer can be regularly used at the hottest available temperature
setting.
Tumble Dry, Normal, Low Heat
A machine dryer can be regularly used at a maximum of Low Heat setting.
Tumble Dry, Normal, Medium Heat
A machine dryer can be regularly used at a maximum of Medium Heat setting.
Tumble Dry, Normal, High Heat
A machine dryer can be regularly used at a High Heat setting.
Tumble Dry, Normal, No Heat A machine dryer can be regularly used only at No Heat or Air Only setting.
Tumble Dry, Permanent Press
A machine dryer can be regularly used only at the Permanent Press setting.
Tumble Dry, Gentle A machine dryer can be regularly used only at the Gentle setting.
Do Not Tumble Dry A machine dryer can not be used. Seek alternate drying method symbol.
Do Not Dry A machine dryer can not be used. Seek alternate drying method symbol.
Line Dry Hang damp garment from line or bar, in or out doors.
Drip Dry Hang dripping wet garment from line or bar, in or out doors, without hand
shaping or smoothing.
Dry Flat Lay out horizontally for drying.
Dry In Shade Usually added to Line or Drip Dry. Dry away from direct sunlight.
WIRING SYMBOL
CARE INSTRUCTIONS INSTRUCTIONS AS FOLLOWS…..
Do Not Wring Do not wring as wiring will cause damage to item.
LAUNDRY LABELS SHEET 3 - GENERAL NOTE: IF IRONING IS NOT A NECESSARY, REGULAR CARE PROCEDURE IT NEED NOT BE MENTIONED. NOTE: SYSTEM OF DOTS INDICATING TEMPERATURE RANGE IS THE SAME FOR ALL IRONING PROCEDURES.
IRON SYMBOL CARE INSTRUCTIONS INSTRUCTIONS AS FOLLOWS…..
Iron, Any Temperature, Steam or Dry
Regular ironing may be needed and can be performed at any available temperature with or without steam is acceptable.
Iron, Low Regular ironing, steam or dry, can be performed at Low setting (110C, 230F)
only.
Iron, Medium Regular ironing, steam or dry, can be performed at Medium setting (150C,
300F).
Iron, High Regular ironing, steam or dry, can be performed at High setting (200C,
290F).
Do Not Steam Steam ironing will harm garment, but regular dry ironing at indicated
temperature setting is acceptable.
Do Not Iron Item can not be smoothed or finished with an iron.
DRY CLEAN SYMBOL
CARE INSTRUCTIONS INSTRUCTIONS AS FOLLOWS…..
Dry clean Dry Clean, any solvent, any cycle any moisture, any heat.
Dry clean, Any Solvent Dry Clean, any solvent. Usually used with other restrictions on proper dry
cleaning procedure.
Dry clean, Petroleum Solvent Only
Dry Clean using only petroleum solvent. Usually used with other restrictions.
Dry clean, Any Solvent Except Trichloroethylene
Any dry cleaning solvent other than trichloroethylene can be safely used.
Dry clean, Short Cycle Can be used with A, P, or F solvent restriction.
Dry clean, Reduced Moisture Can be used with A, P, or F solvent restriction.
Dry clean, Low Heat Can be used with A, P, or F solvent restriction.
Dry clean, No Steam Can be used with A, P, or F solvent restriction.
Do Not Dry clean Garment can not be commercially dry cleaned.
DAILY FOOD GUIDE - GENERAL RECOMMENDED (REFERENCED CANADA’S FOOD GUIDE) NUMBER OF FOOD GUIDE SERVINGS PER DAY:
SERVINGS FOR CHILDREN TEENS ADULTS Sex Girls & Boys Females Males Females Males Females Males
Age in years 2-3 4-8 9-13 14-18 19-50 51+ Vegetables and Fruit 4 5 6 7 8 7-8 8-10 7 7
→ Fresh, frozen or canned vegetables 125ml / ½ cup → Leafy vegetables cooked: 125ml / ½ cup Raw ; 250ml / 1 cup → Fresh, frozen or canned fruit 1 fruit or 125 ml / ½ cup → 100% juice 125 ml / ½ cup
Grain Products Daily Servings; → Bread 1 slice 35g → ½ Bagel 45g → Flat breads ½ Pita or ½ tortilla / 35g → Cooked rice, bulgur or quinoa 125 ml / 1/2 cup → Cereal Cold: 30g Hot: 175 ml / 3/4 cup → Cooked pasta, couscous 125 ml / ½ cup
Milk and Alternatives Daily Servings;
→ Milk or powdered milk (reconstituted) 250 ml / 1 cup → Canned milk, evaporated 125 ml / ½ cup → Fortified soy beverage 250 ml / 1 cup → Yogurt 175 g / ¾ cup → Kefir 175 g / ¾ cup → Cheese 50 g / 1.5 oz
Meat and Alternatives Daily Servings;
→ Cooked fish, shellfish, poultry, lean meat 75g / 2.5 oz / 125ml / ½ cup → Cooked legumes 175ml / ¾ cup → Tofu 150 g or 175 ml / ¾ cup → Eggs 2 → Peanut or nut butters 30ml / 2 tbsp → Shelled nuts and seeds 60 ml / ¼ cup
CARD/PARTY INVITATION LIST GIFT LIST NAME CARD / INVITATION NAME GIFT
PARTY BUDGET: $__________________________________ PARTY INVITATIONS:________________________________ PARTY THEME:_______________________________________________________________________________________ ___________________________________________________________________________________________________ PARTY SUPPLIES:____________________________________________________________________________________ ___________________________________________________________________________________________________
RESERVATIONS / PRIVATE DINNER PLANS OCCASION NAME/NUMBER OF GUESTS DATE TIME
PET RECORD CHART - GENERAL PET’S NAME:_____________________________________________________________________________________________________________ BREED:_____________________________________________________ SEX: MALE FEMALE COLOUR:____________________________________________________ I.D. NUMBER:___________________ DATE OF BIRTH:______________________________________________ PLACE OF BIRTH:_____________________________ OWNER’S NAME:______________________________________________ OWNER’S ADDRESS:__________________________ VETERINARY CLINIC:______________________________________________________________________________________________________ VETERINARY ADDRESS:____________________________________________________________________________________________________ VETERINARY PHONE NUMBER:______________________________________________________________________________________________
VACCINATION DATE AGE DATE AGE DATE AGE DATE AGE DATE AGE Distemper-Hepatitis-CAV2 Parainfluenza Leptospirosis Parvovirus Coronavirus Bordetella Lyme Disease Giardia Rabies
HEALTH RECORD APPOINTMENTS DATE INCIDENT DATE REASON
CHRISTMAS HOLIDAY PLAN - GENERAL ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
CHRISTMAS COSTS / BUDGET - GENERAL
√ DESCRIPTION COST √ DESCRIPTION COST
SECTION ONE Christmas tree ----------------$________ Tree decorations---------------$________ Outdoor decorations-----------$________ Inside decorations-------------$________ Christmas flowers-------------$________ TOTAL---------------------------$________
SECTION TWO Smoke detectors------------------------$________Fire extinguishers-----------------------$________Carbon monoxide detector--------------$________Flashlights-------------------------------$________Batteries--------------------------------$________ TOTAL------------------------------------$________
SECTION THREE Christmas dinner ------------- $________ Extra groceries----------------$________ Baking goods-------------------$________ Holiday treats------------------$________ Ginger Bread House------------$________ TOTAL---------------------------$________
SECTION FOUR Presents--------------------------------$________ Wrapping paper-------------------------$________ Bows, ribbon, tags----------------------$________ Boxes, gift bags-------------------------$________ Crafts, jars, tins-------------------------$________TOTAL------------------------------------$________
SECTION FIVE Alcohol beverages------------- $________ Mix for beverages--------------$________ Entertainment snacks----------$________ TOTAL---------------------------$________
SECTION SIX Shipping paper & tape------------------ $________ Cost of freight to ship parcels----------$________ Christmas cards & stamps--------------$________TOTAL------------------------------------$________
SECTION SEVEN Christmas parties--------------$________ Entertainment, movies---------$________ New Years Eve Party-----------$________ TOTAL---------------------------$________
SECTION EIGHT Babysitters----------------------------- $________ Donations-------------------------------$________ Party clothes----------------------------$________TOTAL------------------------------------$________
CHRISTMAS CARD LIST - GENERAL Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
Name ______________________________ Address ______________________________ City / Province / State ______________________________ Postal Code / Zip Code ______________________________
CHRISTMAS GIFT SHOPPING LIST - GENERAL
NAME GIFT COST PURCHASE AT…
HEALTH SECTION
TABLE OF CONTENTS
PAGE # TOPIC / DESCRIPTION / TITLE
MEDICAL ALERT CONDITIONS / ALLERGIES MEDICAL ALERT CONITIONS
ALLERGIES
EMERGENCY PHONE NUMBERS
IN CASE OF AN EMERGENCY CALL PHONE
NUMBER RELATION
TO ME NAME
NAME
FAMILY DOCTOR
HOSPITAL
POLICE
FIRE
HEALTH CARE PROVIDER
PHARMACY
OTHER
OTHER
IMPORTANT NUMBERS
HEALTH CARE NUMBER
OTHER INSURANCE NUMBER
OTHER NUMBER
MEDICAL HISTORIES
MY MEDICAL HISTORY FAMILY MEDICAL HISTORY
MEDICATIONS - HEALTH
DATE MEDICATION HOW MANY?
AMOUNT? DIRECTIONS / INSTRUCTIONS
COMPLETED?
DAILY RECORD - HEALTH Date: From________________________ To_____________________________
DAY LIST
SLEEP DETAILS
NOTE TODAY’S FEELINGS
LIST TODAY’S
SYMPTOMS
LIST TODAY’S MEDICATION
RECORD APPOINTMENTS
AND NOTES
SUN DATE
MON DATE
TUE DATE
WED DATE
THU DATE
FRI DATE
SAT
JOURNAL NOTES:
DAILY RECORD SHEET 2 - HEALTH DATE: FROM:___________________________________________ TO:_________________________________________
Average 80 proof (40% alcohol) Calories Alcohol (g) Carbohydrate
1/2 shot : 3/4 fl oz 33 5 0
1 shot : 1 1/2 fl oz 65 9.5 0
Double shot : 3 fl oz 130 19 0
1/2 Bottle, 375ml 810 120 0
Coolers & Premixed Cocktails
Calories Alcohol (g) Carbohydrate
Barcardi Silver, 4.9 %, 12 fl. oz 235 14 35
Bartles & James Malt Based Coolers, 3.9 %, 12 fl. oz, av.all flavors 225 11 41
Cruzan Island Cocktails, 5%, 12 fl. oz, av. all flavors 270 14 43
Jack Daniels Country Cocktails, 5.9%, 12 fl. oz, av all flavours 170 10 25
Seagram’s Coolers, 3.2%, 12 fl. oz, av. all flavours 230 12 36
Smirnoff Ice, 5%, 330 ml 225 13 33
The Club, 4 fl. oz, av. all flavours 240 11 38
Table Wine Ready Reckoner
Average All Varieties (11.5% Alcohol) Calories Alcohol (g) Carbohydrate
4 fl. oz (1/2 large wine glass) 85 11 2
6 fl. oz serve (3/4 large wine glass) 125 16 3
1/2 Carafe/Bottle, 375ml 265 34 6
1 Bottle, 750ml Note: Wines contain nil fat.
530 68 13
CHILD’S HEALTH RECORD - HEALTH FOR COMPLETE RECORDS & ROUTINE IMMUNIZATION SCHEDULES, please refer to Canadian Immunization Guide, Seventh Edition, 2006 (Chart below is for record keeping only)
VACCINATION DATE DATE DATE DATE DATE Diphtheria, tetanus, acellular pertussis and inactivated polio virus vaccine (DTaP-IPV): DTaP-IPV(± Hib)
Haemophilus influenzae type b conjugate vaccine (Hib)
MEASUREMENT BEFORE JAN FEB MAR APR MAY JUNWeight Bust Arms Waist Hips Thighs Calves B.M.I. (Body Mass Index) Cholesterol Resting Heart Rate Personal Fat Scale/Budget
MEASUREMENT JUL AUG SEP OCT NOV DEC AFTER
Weight Bust Arms Waist Hips Thighs Calves B.M.I. (Body Mass Index) Cholesterol Resting Heart Rate Personal Fat Scale/Budget
BODY MASS INDEX CHART- FITNESS The table below has already done the math and metric conversions. To use the table, find the appropriate height in the left-hand column. Move across the row to the given weight. The number at the top of the column is the BMI for that height and weight.
GRATITUDE EXPERIENCE – WELLNESS EXERCISE Try the GRATITUDE EXPERIENCE. This is a wellness exercise that may enlighten your daily life and attitude. The exercise runs for an eight week period. The idea of the exercise is to become more grateful for the goodness in your daily life. Use the following sheet to write down at least 5 good things that you are grateful for in your life each day. The situation can be anything positive, big or little, an event or a thought. Some examples might be; 1. I got a raise today! 2. I had my first summer soft ice cream cone today. 3. The snow flakes where huge and beautiful today. 4. My daughter won the dance contest. 5. I met a new friend today. Discover the gratitude experience! The following page present an opportunity for you to experience the changes that gratitude can generate in your daily life. As you record all the things you are grateful for having, for experiencing, for seeing and hearing, you can become aware of all the precious people and the priceless moments that exist in your world. Dealing with problems and issues from day to day can lead us into a stagnant life-style that we do not even realize is upon us. While these problems and issues still need to be dealt with, we can try not to become too consumed by their impact. By intentionally focusing on the positive realities each day, we can modify our attitude and thinking to recognize just how much we truly have to be thankful for. It can develop our mental health, boost our exercise levels and possibly experience sleep improvements. But - the true influence of gratitude cannot be described nearly as well as it CAN be experienced. A soothing consciousness – an awareness, can be aroused into your being, your daily life-style and your awakened world.
GRATITUDE EXPERIENCE – WELLNESS EXERCISE In a few words record 5 observations of gratitude daily; WEEK – DATE : Day 1
MY FITNESS, HEALTH, FINANCIAL, HABITS (etc.) GOALS, REACH GOALS BY (DATE)
THINGS I WANT TO CHANGE IN MY LIFE - WELLNESS
DATE I WANT TO CHANGE…….
DECISION-MAKING PROS & CONS - WELLNESS
DECISION TO MAKE PROS CONS
BALANCED LIFESTYLE - WELLNESS Use the following chart to develop a plan using the four basic elements for living a fulfilled lifestyle.
(i) MIND – list activities that will challenge you intellectually __________________________________________________________________________________ (ii) BODY – list physical activities __________________________________________________________________________________ (iii) SOUL – list your passions or activities that give you great joy to do __________________________________________________________________________________ (iv) HUMAN INTERACTION – list social groups that have your interests in mind
ACHIEVEMENTS / SUCCESSES & TRIUMPHS - WELLNESS
DATE ACHIEVEMENT
SUCCESS TRIUMPH / AWARD
PLACE ATTENDED
PEOPLE ATTENDED /NOTES
SELF HELP AREAS FOR IMPROVEMENT- WELLNESS
AREA START DATE
END DATE ACTION PLAN
Anger Management Anxiety Assertiveness Behavior Modification Codependency Depression Diet / Weight Loss Eating Habits Fitness & Exercise Forgiveness Friendships/Loneliness Goal Setting Gratitude Habits Happiness Investing Listening Skills Love Mind Control / Power Motivation Nutrition Overcoming Fear Positive Thinking Relaxation Self Esteem Stress Management Time Management
INSURANCE Home Health Life Other____________________
FOODGroceries Dining out Other_______________________ Other_______________________
PETS Food Medical Grooming Toys Other____________________ Other____________________ Other____________________
PERSONAL CAREMedical Hair/nails Clothing Dry cleaning Health club Organization dues or fees Other_______________________
ENTERTAINMENT Video/DVD CDs Movies Concerts Sporting events Live theater Other_____________________ Other_____________________ Other_____________________
LOANSPersonal Line of Credit Credit card Credit card Credit card Other_______________________ Other_______________________ Other_______________________ Other_______________________
TAXES Federal State/Provincial Local Other_____________________
SAVINGS OR INVESTMENTS Retirement account Investment account Other_______________________ Other_______________________
GIFTS AND DONATIONS Charity 1 Charity 2 Charity 3 Other_____________________
LEGALAttorney Alimony Payments on lien or judgment Other_______________________
MONTHLY PAYMENTS - FINANCES ITEM AMOUNT DUE DUE DATE NOTES - √
Mortgage Rent Phone Cell Hydro Gas Oil Cable Internet Life Insurance House Insurance Car Insurance Credit Cards Car Payment Property Taxes Personal Taxes Loan Payment RRSP Investment Totals
MONTHLY APPOINTMENTS / REMINDERS Doctor Appointment Dentist Appointment Car Appointment Bank Appointment Hair Appointment Eye Dr. Appointment Birthdays Anniversaries
BASIC MONTHLY EXPENSES- FINANCIAL List all incomes (including spouse) $ AMOUNT $ Total Income(s) List all expenses (including spouse) $ AMOUNT $ Total Expense(s)
BALANCE: $_________________ MINUS WITHDRAWALS / CHEQUES / SERVICE CHARGES TOTAL CHEQUES:----------------------------------------------------$__________________ AUTOMATIC PAYMENTS:--------------------------------------------$__________________ SERVICE CHARGES:-------------------------------------------------$__________________ OTHER DEBITS: --------------------------------------------------$___________________ ___________________:-----------------------------------------------$___________________ SUBTOTAL: $__________________
Check off the list below to ensure you have all pertinent information stored in a fireproof, safe and secure place. WARNING! DO NOT RECORD ANY TOP SECRET OR CONFIDENTIAL INFORMATION HERE. Verbally tell your ‘trusted person(s)’ the whereabouts of the following;
Set up / inform your ‘trusted person(s)’ and advisors
Create a list of ‘Who to call first’
Create an ‘Emergency contacts’ list
Will and estate documents
Funeral arrangements
Insurance policies
Medical information
Deeds, mortgages, other important property papers
Investment statements
Banking records
Business information
Tax returns
Intellectual property, copyrights, trademarks
Codes, passwords
Keys, combinations
Computer passwords
Special words for special people
Other top secret & confidential information
Other ___________________________________________________________
Other ___________________________________________________________
Other ___________________________________________________________
Other ___________________________________________________________
BATHROOM #2 Garden Tools House Plants Curtains Furniture Pool Equip. Floor Mats Luggage Air Conditioner Wash Machine Dryer Deep Freeze Freezer Content TOTAL TOTAL TOTAL TOTAL
PERSONAL PROPERTY INVENTORY SHEET 3 - ORGANIZATION
CLOTHING AND LINENS CHINA, CRYSTAL, ETC. ARTICLE REPLACEMENT
HOW MANY SMOKE ALARMS DO YOU HAVE?______________________________________________________ Draw a floor plan or a map of your home. Show all doors and windows. Mark two ways out of each room. Smoke alarms should be in each sleeping room, outside each sleeping area, and on every level of the home. Pick a family meeting place outside where everyone can meet. Practice your plan at least twice a year!
OUR FAMILY - FAMILY
GRANDPARENTS GRANDPARENTS
PARENTS PARENTS
GENERATION ONE
GENERATION TWO
FAMILY BIRTHDAY LIST - FAMILY
DATE TIME PLACE WEIGHT FULL NAME BIRTHSTONE
FAMILY WEEKLY SCHEDULE - FAMILY DAY TIME
NAME: ________________
NAME: ________________
NAME: ________________
NAME: ________________
MORNING:_______ EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT
SUN
DATE:_______ EVENING:________
EVENT
EVENT EVENT EVENT
MORNING:_______ EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT
MON
DATE:_______ EVENING:________
EVENT
EVENT EVENT EVENT
MORNING:_______ EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT
TUE
DATE:_______ EVENING:________
EVENT
EVENT EVENT EVENT
MORNING:_______ EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT
WED
DATE:_______ EVENING:________
EVENT
EVENT EVENT EVENT
MORNING:__________
EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT THU
DATE:_______
EVENING:________ EVENT
EVENT EVENT EVENT
MORNING:_______ EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT
FRI
DATE:_______ EVENING:________
EVENT
EVENT EVENT EVENT
MORNING:_______ EVENT
EVENT EVENT EVENT
AFTERNOON:_____ EVENT
EVENT EVENT EVENT
SAT
DATE:_______ EVENING:________
EVENT
EVENT EVENT EVENT
COMPANY / GUEST / VISITORS - FAMILY
Family Name:________________________ Arrival:______________ Departure:___________ First Names:__________________________________________________________________________
Contact Phone Numbers: _______________________________________________________________ Transportation Requirements:___________________________________________________________ Accommodations: _____________________________________________________________________ Special Diets / Instructions: ____________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Family Name:________________________ Arrival:______________ Departure:__________ First Names:__________________________________________________________________________ Contact Phone Numbers: _______________________________________________________________ Transportation Requirements:___________________________________________________________ Accommodations: _____________________________________________________________________ Special Diets / Instructions: ____________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
“FIND IT” TREASURE NOTES - FAMILY USE “FIND IT” TREASURE NOTES TO CREATE A TRAIL FOR A CHILD TO SEARCH FOR A LITTLE TREASURE THAT IS A TOY, A GIFT OR A TREAT. EACH NOTE LEADS CLOSER TO THE ‘TREASURE’! DRAW OR PRINT A CLUE OR HINT THAT LEADS TO THE NEXT NOTE. THE ‘TREASURE’ (TOY, REWARD, GIFT OR TREAT) CAN BE FOUND AFTER 4 OR 8 CLUES DEPENDING ON THE AGE OF THE CHILD.
CLUE NUMBER _____________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
CLUE NUMBER _____________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
CLUE NUMBER _____________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
CLUE NUMBER _____________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
FAMILY TREE GENERATION 1 - 3 – FAMILY OUR FAMILY TREE – NAME:________________________________
Husband’s Full Name: Wife’s Full Name: Date of Marriage: Place of Marriage: Our Children:
GENERATION #2 GENERATION #2
GENERATION #3 GENERATION #3
Generation 3 continues next page……
Husband’s Father’s Full Name: Husband’s Mother’s Full Name: Date of Marriage: Place of Marriage: Children:
Wife’s Father’s Full Name: Wife’s Mother’s Full Name: Date of Marriage: Place of Marriage: Children:
Wife’s Paternal Grandfather’s Full Name: Wife’s Paternal Grandmother’s Full Name: Date of Marriage: Place of Marriage: Children:
Husband’s Paternal Grandfather’s Full Name: Husband’s Paternal Grandmother’s Full Name: Date of Marriage: Place of Marriage: Children:
FAMILY TREE GENERATION 3 Con’t & 4 - FAMILY GENERATION #3 GENERATION #3
GENERATION #4 GENERATION #4
HUSBAND’S GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GRANDMOTHER’S FULL NAME
Husband’s Maternal Grandfather’s Full Name: Husband’s Maternal Grandmother’s Full Name: Date of Marriage: Place of Marriage: Children:
Wife’s Maternal Grandfather’s Full Name:
Wife’s Maternal Grandmother’s Full Name: Date of Marriage: Place of Marriage: Children:
FAMILY TREE GENERATION 5 - FAMILY GENERATION #5 GENERATION #5
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDFATHER’S FULL NAME
WIFE’S GREAT GREAT GRANDFATHER’S FULL NAME
HUSBAND’S GREAT GREAT GRANDMOTHER’S FULL NAME
WIFE’S GREAT GREAT GRANDMOTHER’S FULL NAME
FAMILY TREE GENERATION 6 - FAMILY GENERATION #6 GENERATION #6
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
HUSBAND’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
WIFE’S GREAT GREAT GREAT GRANDPARENT’S FULL NAME
OUR FAMILY
_________________________________________
Joined
_________________________________________
In marriage
At____________________________________________________________________________ Address______________________________________________________________________ Month_____________________________ Day________________________ Year___________ Married by____________________________________________________________________
HUSBAND’S GENEALOGY WIFE’S GENEALOGY Husband’s full name;____________________ ______________________________________ Birth Date;____________________________ Birth Place;____________________________ Father’s full name;______________________ ______________________________________ Mother’s full name;_____________________ _____________________________________ Brothers and sisters;___________________ ______________________________________ ______________________________________
Wife’s full name;_____________________________ ___________________________________________ Birth Date;__________________________________ Birth Place;_________________________________ Father’s full name;___________________________ ___________________________________________ Mother’s full name;__________________________ ___________________________________________ Brothers and sisters;________________________ ___________________________________________ ___________________________________________
FAMILY TREE INDEX
PAGE# TITLE PAGE# TITLE
FAMILY TREE - OUR (GRAND)/CHILDREN
OUR CHILDREN
FULL NAME PLACE OF BIRTH DATE OF BIRTH
OUR GRANDCHILDREN
FULL NAME PLACE OF BIRTH DATE OF BIRTH
FAMILY TREE – SIBLINGS/NIECES/NEPHEWS HUSBAND, HIS BROTHERS AND SISTERS AND THEIR CHILDREN; BORN DIED SPOUSE ___________________________________________________________________________________________________ CHILDREN_______________________________________________ _____________________________________________________________________________________ CHILDREN_______________________________________________ _____________________________________________________________________________________ CHILDREN_______________________________________________ _____________________________________________________________________________________ CHILDREN_______________________________________________ _____________________________________________________________________________________ CHILDREN_______________________________________________ WIFE, HER BROTHERS AND SISTERS AND THEIR CHILDREN; BORN DIED SPOUSE ___________________________________________________________________________________________________ CHILDREN_______________________________________________ ___________________________________________________________________________________________________ CHILDREN_______________________________________________ ___________________________________________________________________________________________________ CHILDREN_______________________________________________ ___________________________________________________________________________________________________ CHILDREN_______________________________________________ ___________________________________________________________________________________________________ CHILDREN_______________________________________________ ___________________________________________________________________________________________________ CHILDREN_______________________________________________
THIS BOOK BELONGS TO….. ________________________________ ________________________________
MY SCHOOL DAYS - INDEX
PAGE# TITLE PAGE# TITLE
MY SCHOOL DAYS – GRADES____ TO ____
SCHOOL:____________________________ TEACHER:________________ GRADE:_______________ SCHOOL YEAR DATE: START:__________________________ FINISH:______________________ HEIGHT:_______________ WEIGHT:___________ AGE:__________ YEAR:__________
___________________________________________
SIGNATURE
NEW FRIENDS:_________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ EXTRA ACTIVITES:______________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ SPECIAL EVENTS ATTENDED:_____________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ ACHIEVEMENTS / AWARDS:______________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________
PHOTO
MY SCHOOL DAYS – MEMORIES / MILESTONES
WHEN I GROW UP I WANT TO BE;_________________________________________________________ MY CLOSEST FRIENDS;__________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ CLUBS AND ACTIVITIES I JOINED;_________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SPECIAL EVENTS I ATTENDED;____________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ CERTIFICATES AND AWARDS I RECEIVED;__________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ MY ACADEMIC GOALS;___________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ MEMORIES AND MILESTONES;_____________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Hotel Phone#: _______________ Hotel Room #: _______________
Other Information: _______________ Other Information: _______________ Other Information: _______________ Other Information: _______________ NOTES: _________________________ ________________________________ ________________________________
Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________
PETS Boarding/Ship: $_______________
Pet Supplies: $_______________ Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________
ADDITIIONAL COSTS Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________ Other Fees: $_______________
VACATION SCHEDULER - TRAVEL
PUBLIC HOLIDAYS CIRCLE DATES & RECORD VACATIONS BELOW New Year's Day Jan. 1 ___________________________________ Family Day Feb. 18 Good Friday March 21 ___________________________________ Easter Sunday March 23 Victoria Day May 19 ___________________________________ Canada Day July 1 Labour Day Sept. 1 ___________________________________ Thanksgiving Day Oct. 13 Remembrance Day Nov. 11 ___________________________________ Christmas Dec. 25 Boxing Day Dec. 26 ___________________________________