Lost Your Password?
Please circle answers where applicable
Who will take care of the child during illness?
What forms of discipline are most often used in the child’s home?
How does your child behave when sick?
How is your child most easily settled when upset or afraid?
What are your child’s favorite activities, toys, books, or games?
What is your child’s favorite food?
What foods does your child dislike?
Drinks from CupCup w/lidBottleBreast fed
Eats with SpoonHands
Eats table foods (please specify if limited)
Any food allergies or special needs?
What are your child’s mealtime routines at home?
Does he/she sleep through the night? YesNo
Does your child take an afternoon nap? YesNo How long?
Special toy or blanket for naptime? YesNo What?
What is his/her mood upon awakening?
Where does he/she sleep at home? ---CribBed
How many hours of sleep does your child receive at night?
Is your child potty trained? YesNo
If toilet training, does child indicate bathroom needs? YesNo
Can your child be relied upon to indicate bathroom wishes? YesNo
Does your child have any “accidents”? YesNo
What words does your child use for: Urination: BM’s:
Does your child wear: DisposableDiapersPull-upsUndies
Do you use: DesitinPowderSpecial WipesOther
Please state, if other.
Is diaper rash a problem? If so, how do you treat it?
Does child wear diapers/pull-ups while napping? YesNo
Does your child Stand/Sit on toilet? ---SitStand How often?
Does your child need help with toileting? YesNo
Is diarrhea or constipation a problem? YesNo
Does child have an “unsettled” time? When?
What do you do?
How does child relate to strangers?
What if anything do you do for teething?
What does your child enjoy doing the most?
What are your child’s favorite toys?
With whom does this child reside? Please fill in names and relationships and ages of other children in the family:
Who else also cares for your children regularly?
Is another language, besides English, spoken in your home? ---YesNo If yes, which?
Does your child have any medical or physical needs? ---YesNo Explain:
How does your child express anger or react to frustration?
Does your child have any particular fears? ---YesNo Explain:
How does your child comfort himself?
When did your child begin to use language?
How would you describe your child (personality characteristics)?
What do you enjoy most about your child?
Is there anything else in your child’s experience you would like to tell us so we can better meet your child’s needs?
Has your child had previous daycare or preschool experiences? ---YesNo
Where was your child enrolled?
Please tell us about them.
Do you have a special interest or hobby you would be willing to share with the children?