TELL ME ABOUT YOUR CHILD (fill out upon enrollment)                                  Date:

 

Name of Child:                                                       M   or   F                                    

 

Name of Child:                                                       M   or   F                                    

 

What are you looking for in a childcare and childcare provider?

 

Do you have a routine with your child? (waking time) (nap time) (bedtime):

Has your child had previous childcare / preschool experience? How are they with separation? Please describe.

 

 

Can I contact your previous childcare provider? If so, provide the name and number.

 

 


 

 Does your child adapt easily to changes in routine?

 

 

Describe your child’s typical day on the weekends (waking time) (nap time) (bedtime):

 

 

Does your child usually sleep through the night?  How do you put your child to sleep? Where do they sleep?

 

 

How do you handle your child’s misbehavior? (What is your philosophy of discipline?)

 

 

What methods do you use to encourage your child’s good behavior?

 

 

How does your child react to extremes in the environment? (such as loud noises, heat, cold, etc):

 

 

How well does your child play by themselves?                                                  How well does your child play with others?

 

 

List play activities your child enjoys:                                 

 

 

If your child has a pet, what is its name and what type of pet is it:

 

 

Favorite Food:                  Favorite Song:                     Favorite Story:                   Favorite Toy:                           Favorite Color:

 

 

Siblings: Age:                                                 Siblings: Age:                                                        Siblings: Age:

 

 

What comforts your child best?                 Likes:                                                           Dislikes:

 

 

Any additional notes: