“About Your Child” Form
About Your Child
Child's Name: _________________________________________________
Age: ________________________________________________________
Has your child been in daycare before: Yes / No
If yes, any problems at previous daycare:
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Is your child toilet trained: Yes / No
What words does your child use for toilet:
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What foods does your child especially like:
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Especially dislike:
___________________________________________________________
Favorite toys, games, activities:
___________________________________________________________
How does your child express anger or frustration:
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Does your child have any special fears:
___________________________________________________________
___________________________________________________________
When your child is upset, what helps to comfort him/her:
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___________________________________________________________
How do you discipline your child:
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Does your child take an afternoon nap Yes / No If yes, how long:
___________________________________________________________
Special toy or blanket for nap:
___________________________________________________________
Special family situations (custody situation, alternate pick-up or drop off person, etc.):
___________________________________________________________
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Anticipated adjustment problems:
___________________________________________________________
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Any disorders/developmental (slow, advanced) diagnosed or suspected: Yes / No If yes, Explain:
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Other comments:
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