Please fill out the questionnaire if your child is a new student.

Child's Name:

First Name

Last Name

Nickname:

Child's date of birth:

Has your child had group experiences before?

Previous childcare situation:

Favorite toys, books, activities:

How does your child express anger and/or frustration?

Does your child have any special fears (dogs, storms, etc)?

When your child is upset, what helps to comfort him/her?

Can your child use the toilet independently?

Does he/she need to be reminded to use the bathroom?

What words does your child use for toileting?

Does your child sleep at naptime?

If so, for how long?

Are there any special family situations (such as new baby, parent travel, illness, etc.) affecting your child?

What language(s) do you use at home?

What would you like us to know about your child?

What would you like us to know about your family?