Child Habit Tracker Setup Form
Set up and customize a habit tracking plan for your child. Provide details to help monitor and encourage positive habits.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
*
First Name
Last Name
Child's Age
*
Select the habits you want to track for your child
*
Brushing teeth
Making bed
Finishing homework
Reading
Helping with chores
Eating vegetables
Other (please specify)
How often do you want to track these habits?
*
Daily
Weekly
Other (please specify)
Preferred start date for habit tracking
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Would you like to use a reward system to encourage your child?
*
Yes
No
If yes, please describe the type of rewards or motivation you plan to use
Do you want to receive progress updates?
*
Yes, by email
Yes, by SMS
No updates needed
Additional notes or special instructions
Set Up Habit Tracker
Should be Empty: