Child's Information Sheet

Child's name: DOB:

Chronic illnesses: __________________________________

Any known allergies? (Asthma, Hay Fever, Insect Bites, Medicines, Food, etc.)

_____________________________________________________________

Is your child Toilet Trained? ______________________________________________

What words does your child use for toilet? ___________________________________

Are any medications given regularly?

Child's favorite toys, activities, etc.:

Favorite Foods: ________________________________________________

Briefly describe your child's behavior: ________________________________

What makes your child mad or upset? ________________________________

How does your child show feelings? __________________________

What do you find is the best way of handling your child? _______________________

_____________________________________________________________

How do you discipline youur child? ________________________________________

Any disorders/developmental (slow, advanced) diagnosed or suspected? ___________

Any special needs required for your child? ________________________________

Special family situations? (such as custody specifications, problems arising from situations, etc.)

________________________________________________________________

Anticipated adjustment problems? _________________________________________

Has your child been taking an afternoon nap? _______________________

If so, how long?________________________________________________

If not, why no nap? _____________________________________________

Special toy or blanket for nap time?

Name of previous daycare provider/center: _________________________________

Reason for leaving previous daycare setting: ________________________________

______________________________________________________________

Other comments: _________________________________________

______________________________________________________________

____________________________________________ _____/_____/_____

Parent/Guardian Date