Family Questionare Child's Name * First Name Last Name Date of Birth * MM DD YYYY Nickname My Family Parents or Guardian * Please let us know if you are a guardian, if parents live somewhere other than the home, step parent, etc. Sibling Names & Ages * Other relatives or people your child is close to and sees often: * What language does your family speak at home? * List traditions, cultural activities, and/or religious events your family participates in: * Sleeping Patterns How does your child say/show they are ready to sleep? * How do you prepare the child for a nap? (rocking, swinging, etc.) * How long does your child approx. nap for? * Eating Patterns Are there any eating difficulties? * Does your child have allergies? * Do you have nutrition concerns we should be aware of? * Health Patterns Does your child regularly take medications? * If so your child requires medication during program hours, you will need to fill out the proper medication consent form Are there any health problems or special care required? * If yes, please state specifically Stress/Coping Patterns: Describe your child's teething symptoms: * Is there any other information we should know that will help us get acquired with your child? * Thank you!
