All About Your Child Step 1 of 2 50% All About Your ChildChild’s Full Name* First Last NicknameChild's DOB (MM/DD/YYYY)*Grade*InfantToddlerPreschoolerKindergarden All About Your Child- InfantHas your child been in childcare before?*YesNoIf yes, was it a positive experience?*Reason Care was terminated?*What other information should I know/be aware of to care for your child as an individual?* Events at home often influence your child’s behavior. I am better able to help your child when you inform me of the situations and/or events that might influence his/her overall behavior such as: - Divorce/Separation of Parents - Separation from a relative or friend - Death of a relative or friend Child Lives with:*MomDadBothIs anyone legally restricted from seeing your child?*YesNoAttach the legal court documentation supporting this. Please note that LSA cannot withhold a child from a parent or guardian without the proper legal documentation. Drop files here or Is English the primary language used in the home?*Are any languages besides English used in the home?*Is your baby breast fed or formula fed?*If breast fed, does your baby take a bottle?*How many ounces per feed?*How often do they take a bottle?*Have you started your baby with solid foods?*Are they able to feed themselves finger foods?*YesNoUse a spoon?*YesNoHow much/how often does your baby eat?*Does your child have a regular bedtime schedule/routine?*YesNoWhat time does your child usually go to bed at night?*What time does your child usually wake up in the morning?*Do they sleep through the night?*Do they sleep in a bed or crib, other?*How long is your Infants wake window (how often do they nap)?*How long does your infant sleep for?*Does your child have any problems getting to sleep or staying asleep?*YesNoIf yes, explain*How does your baby sleep?* Swaddled Sleep Sack Free in Bed Do you use a sound machine at home?*YesNoDoes your child have any security objects such as a blanket, soother, bottle, toy, binky, etc.?*Is your child able to Roll Over Belly to back?*YesNoAlmostIs your child able to Roll Over Back to Belly?*YesNoAlmostAre they sitting up on their own?*YesNoAlmostAre they crawling or walking?*Almost CrawlingCrawlingAlmost WalkingWalkingNot ApplicableNormal Drop off Time*pick up time*What helps soothe them when they are upset?*Allergies*I have the following special health problems/needs*Other Important information*All About Your Child- One and UpHas your child been in childcare before?*YesNoIf yes, was it a positive experience?*Reason Care was terminated?*What other information should I know/be aware of to care for your child as an individual?* Events at home often influence your child’s behavior. I am better able to help your child when you inform me of the situations and/or events that might influence his/her overall behavior such as: Divorce/Separation of Parents Separation from a relative or friend Death of a relative or friend Child Lives with*MomDadBothIs anyone legally restricted from seeing your child?*YesNoAttach the legal court documentation supporting this. Please note that LSA cannot withhold a child from a parent or guardian without the proper legal documentation.* Drop files here or Which hand does your child prefer to use?*RightLeftBothIs English the primary language used in the home?*Are any languages besides English used in the home?*Does your child have a regular bedtime schedule?*YesNoWhat time does your child usually wake up in the morning?*What time does your child usually go to sleep/bed at night?*Do they sleep through the night?*Does your child sleep in a bed, crib or other?*Does your child take naps? If yes, how long does your child usually nap?*Does your child have any problems getting to sleep or staying asleep? If yes, explain*Does your child have any security objects such as a blanket, soother, bottle, toy etc?*What word(s) does your child use for urine?*Bowel Movement?*What responsibility does your child assume in toileting?*Is your child able to sleep through nap/night without accidents?*Child's Age*Birthday*Address*Phone Number*Mom’s name*Dad’s name*Number of siblings*Favorite color*The thing that child is afraid of most*Number of pets*They are this kind of animal and their names are:AnimalName Allergies*I have the following special health problems/needs*Other Important information*Thank you for filling this out, we know it is a novel but it really does help us relate to your children and for those learning to talk, decipher what they may be saying!Add another child?*YesNo
