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Child's Family Information Sheet
Our teachers would apprecaite knowing about your child and family so that they may be aware of your child's unique needs and circumstances.
Child's Name:
*
Nickname:
Sex:
*
Male
Female
Birthdate:
*
+
Mother's Name:
Father's Name:
Home Phone:
Names and ages of siblings:
Adults who live in the home with your child:
Please list the names and kinds of pets in your home:
My child's favorite activities include:
My child's least favorite activities include:
My child's strengths include:
Does your child have a job at home:
Does your child have any fears?
Does your child have a security item?
As teachers, you can help my child most by:
My child needs help with:
Has your child experienced any emotional distress in the recent past?
Is your child receiving any special services from County agencies or from a private source?
What opportunities has your child had to play with other children?
This year I would like my child to:
I would like you to know that:
We are required by licensing regulations to obtain the following information on previous enrollment in school or daycare. If a question does not apply to you, please write n/a in space provided.
Is this your child's first year in school?
*
Yes
No
Please give the name and location of precious school(s) and number of year(s) attended.
*
Has your child ever been with a caregiver during the day?
*
Yes
No
If your child is currently with a caregiver, please indicate the number of hours:
*
Care is provided at:
*
How many other children are with the caregiver?
*
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