All About Me - The Daycare Lady
All About Me
All the information provided on this form is requested so I can get to know your child and help the adjustment period go a little smoother. It will all be kept confidential.
Child’s Name: ______________________________________________________________
Birthdate: _______________________________________________________________
Your Child:
Please circle all the words that best describe your child: calm, shy, excitable, happy, sensitive, cheerful, loud, quiet, easily angered, stubborn, curious, active, destructive, gives in easily, temper tantrums, jealous, shares well, hyperactive, bright, slow learner, busy, contented, other: _______________________________________
How well does your child get along with other children? ______________________________
Child’s Favorite Games, Activities, Etc.: __________________________________________
What Makes Your Child Mad Or Upset: __________________________________________
What Do You Find Is The Best Way Of Handling Your Child: _________________________
Are there any "family" rules I should be aware of? _________________________________
Any Special concerns or comments? ___________________________________________
Eating Habits:
Favorite Foods: _________________________________________________________
Least Favorite Foods: _____________________________________________________
Day Care Experiences:
How many day cares has your child been in? ______________________________________
Reason for leaving last day care? _______________________________________________
Name and Telephone number of last day care provider or center? _______________________
Any special concerns? _______________________________________________________
Medical Information:
List child's frequent illnesses: ___________________________________________________
Any Known Allergies? (Asthma, Hay Fever, Insect Bites, Medicines, Food, Etc.) ____________
What communicable diseases has your child had? (chicken pox, measles, mumps)? ___________
Are Any Medications Given Regularly? ___________________________________________
Are there any special medical concerns I should know about? ____________________________.
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