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Preschool (3-5 Years Old) Development & Routine

We want to provide your child with the best care possible. Please help us to get to know your child by filling out this questionnaire. 

Child's Nameyour full name
Name and Ages of Siblingsyour full name

DAILY ROUTINES

SLEEPING

Please describe your child's usual bedtime routine (including what time and where he/she usually sleeps).more details
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How do you know that your child is sleepy/tired?more details
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Does your child have any difficulties falling asleep? (If yes, what is helpful?)more details
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About how many hours of uninterrupted sleep does your child get each night?more details
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Does your child nap? (If yes, how many hours on average?)more details
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Does your child sleep with a special blanket, toy, pacifier, song?more details
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Do you have any concerns about your child's sleep habits? (If yes, please explain.)more details
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EATING

Does your child generally enjoy eating?more details
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Do you consider your child a good eater?more details
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What are some of your child's favorite foods (temperatures, textures, etc.)?more details
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Is your child on any special diet?more details
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If your child has any food allergies, please list here:more details
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Are there any other foods you do not want us to offer your child?more details
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Are there foods from your home/culture that you would like us to offer?more details
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What does your child eat with?
What does your child use to drink?
Do you have any concerns or questions about your child's eating habits? If yes, please explain.more details
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TOILETING

What does your child usually wear during the day?
For Naps?more details
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Families use a variety of words to describe bathroom activities. Indicate the words your family uses for:

urinemore details
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bowel movementmore details
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genital areamore details
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Do you have any questions or concerns about your child's toileting habits? If yes, please explain.more details
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PLAY

What is your child's favorite toy/object or song?more details
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Does your child enjoy playing with others?more details
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Does your child do well playing alone?more details
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What activities and toys does your child enjoy?more details
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Does your child have any pets? If so, please list the name and kind of pet.more details
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HEALTH

Does your child have any health problems? If yes, please explain.more details
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Is your child taking any medication(s) regularly? If yes, please list.more details
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Does your child have a chronic health condition or specific health needs? (Please be specific.)more details
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Does your child have frequent ear infections or diarrhea? If yes, please indicate which one(s).more details
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Do you have any concerns about your child's health? If yes, please explain.more details
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Children in group care may become ill with colds, viruses, etc. several times a year. At times, we are required to ask parents to keep their children out of child care until treatment begins or there are no symptoms. Please see our Exclusion policy.



GENERAL DEVELOPMENT

Do you have any concerns about your child's:

Hearing and/or vision?your full name
Speech and Language Development?your full name
Ability to Move?your full name
Overall development?your full name
What languages are spoken at home?your full name
What is your family's cultural identification (values, traditions)?your full name

SOCIAL AND EMOTIONAL DEVELOPMENT

Has your child ever been in group child care?
If yes, how many different settings?your full name
How does your child respond in group situations?your full name
What can we do to help your child adjust to child care?your full name
How would you describe your child's temperament and personality?your full name
How do you comfort your child?your full name
Does your child use a special comforting item (such as a blanket, stuffed animal, doll)?your full name
Does your child fear certain things?your full name
How is your child disciplined?your full name
What works best when you discipline your child?your full name
Do you have any questions or concerns about your child's social/emotional development or behavior? If yes, please explain.more details
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What educational/developmental experiences would you like us to emphasiz with your child (for example, language development, social relationships, kindergarten readiness skislls, physical or self-help skills, etc.)more details
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Commentsmore details
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