[] 1 Step 1 Toddler (up to 36 months) 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 details0 / How do you know that your child is sleepy/tired?more details0 / Does your child have any difficulties falling asleep? (If yes, what is helpful?)more details0 / About how many hours of uninterrupted sleep does your child get each night?more details0 / Does your child nap? (If yes, how many hours on average?)more details0 / Does your child sleep with a special blanket, toy, pacifier, song?more details0 / Do you have any concerns about your child's sleep habits? (If yes, please explain.)more details0 / EATING Does your child generally enjoy eating?more details0 / Do you consider your child a good eater?more details0 / What are some of your child's favorite foods (temperatures, textures, etc.)?more details0 / Is your child on any special diet?more details0 / If your child has any food allergies, please list here:more details0 / Are there any other foods you do not want us to offer your child?more details0 / Are there foods from your home/culture that you would like us to offer?more details0 / What does your child eat with?HandsSpoonFork What does your child use to drink?Tippy CupRegular Cup Do you have any concerns or questions about your child's eating habits? If yes, please explain.more details0 / TOILETING What does your child usually wear during the day?UnderwearDiaperPull-ups? For Naps?more details0 / Families use a variety of words to describe bathroom activities. Indicate the words your family uses for: urinemore details0 / bowel movementmore details0 / genital areamore details0 / Do you have any questions or concerns about your child's toileting habits? If yes, please explain.more details0 / PLAY What is your child's favorite toy/object or song?more details0 / Does your child enjoy playing with others?more details0 / Does your child do well playing alone?more details0 / What activities and toys does your child enjoy?more details0 / Does your child have any pets? If so, please list the name and kind of pet.more details0 / HEALTH Does your child have any health problems? If yes, please explain.more details0 / Is your child taking any medication(s) regularly? If yes, please list.more details0 / Does your child have a chronic health condition or specific health needs? (Please be specific.)more details0 / Does your child have frequent ear infections or diarrhea? If yes, please indicate which one(s).more details0 / Do you have any concerns about your child's health? If yes, please explain.more details0 / 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?YesNo 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 details0 / 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 details0 / Commentsmore details0 / Submit Form Previous Next
