| In Conclusion |
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| Child's Name: _________________________________________________________ |
| Nickname: ________________________________ DOB: _____________________ |
| Previous child care __________________________________________________________________ |
| Reason for leaving ___________________________________________________________________ |
| Phone Number or address of previous childcare: ________________________________________ |
| Social Habits |
| Is this your child's first separation from you? _______________________________________________ Has your child had group experiences before? _____________________________________________ |
| Does your child make friends easily? _____________________________________________________ |
| Does your child tend to play alone or with others? ___________________________________________ |
| Favorite toys, games, activities? _________________________________________________________ |
| How does your child express anger or frustration? ___________________________________________ |
| Does your child have any special fears? ___________________________________________________ Please explain ______________________________________________________________________ |
| When your child is upset, what helps to comfort him/her? _____________________________________ |
| Eating Habits |
| At what time does the child eat: |
| breakfast ( ), lunch ( ), dinner ( ), snacks ( ) |
| Does the child feed him/herself? (circle all that apply) Spoon Fork Knife |
| Child drinks from a bottle sipper cup regular cup (circle all that apply) |
| Favorite foods: ______________________________________________________________________ ___________________________________________________________________________________ |
| Disliked foods: ______________________________________________________________________ __________________________________________________________________________________ |
| At home child drinks 2% milk whole milk Other Breast Milk Formula (circle all that apply) What brand of formula? _______________________________________________________________ |
| Foods child shows allergy or reaction to___________________________________________________ |
| General eating habits and attitude toward meal time__________________________________________ |
| ____________________________________________________________________________________ |
| Is your child used to a ________scheduled mealtime or _________"feeding on demand"? |
| Toilet Habits |
| Is your child toilet trained? ____________________________________________________________ |
| Can child use toilet independently? ________________________________________________________ |
| Does (s)he tell you when (s)he needs to use the bathroom? ___________________________________ |
| What words does your child use for toilet? ___________________________________________________ |
| Does your child have accidents? or wet the bed at naptime? _____________________________________ |
| If yes, how often? __________________________________________________________________ |
| Sleep Habits |
| Child has room alone______, shares with other children________, sleeps with parents ________ |
| Does the child's bedtimes and waking times vary? ____________________________________________ |
| At night, sleeps from _________________________to____________________ (Usual Times) |
| Does your child nap? If so, Naps from _________________to______________ (Usual Times) |
| Do you want me to wake your child from his/her nap? __________________________________________ |
| Attitude towards going to bed/nap_________________________________________________________ |
| Special nap or bedtime routine? __________________________________________________________ |
| Family Life |
| To better understand your child are there any special family situations? (such as custody, guardianship, problems arising from them, illnesses, deployments etc.)______________________________________ |
| ____________________________________________________________________________________ |
| Primary language spoken in the home: ____________________________________________________ |
| Any allergies, special needs, or developmental (slow, advanced) concerns (diagnosed or suspected)?__________________________________________________________________________ |
| ____________________________________________________________________________________ |
| Holidays |
| Please list special holidays your family celebrates: ___ Thanksgiving ____Hanukkah ___ Christmas |
| _____ New Years Day _____ Halloween ______Kwanza _____Chinese New Year |
| _____ St. Patrick's Day ______ Purim ______ Valentine's Day _____Easter _____No Holidays |
| Other (s): _________________________________________________________________________ |
| Would you be interested in sharing your special holidays with the daycare? _____________________ |
| Talents |
| Are there any talents you would like to share with us? _____________________________________ |
| Would you like to volunteer in any way? _________________________________________________ |
| Do you anticipate any adjustment problems? _______________________________________________ |
| ___________________________________________________________________________________ |
| Your expectations of Greatest Resource Educational Care_____________________________________ |
| ____________________________________________________________________________________ |
| How did you hear about my childcare home? _____________________________________________ May I refer future clients of my business to you for references? _______________________________ |
| If yes, what method of contact do you prefer? ______________________________________________ |
| Thank you for taking the time to complete this profile. It will help me understand and meet the individual needs of your child. Use the bottom of this paper for any concerns, comments, or additional information. |
| Thank You |
| Parents are encouraged to participate in their child's experiences at Greatest Resource. I understand that direct involvement is not always possible. There are other ways you can contribute to our program such as: sharing interests and skill, perhaps associated with cultural traditions, careers or hobbies; taking responsibility for repairing toys and equipment; assisting on field trips; donating craft supplies; etc. Any other ways you can think of to be involved, I would be happy to discuss with you. |
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