CHILD PROFILE FORM
Child’s NameChild’s Birthday
Day(s) Attending
Parent’s Names
Address
Phone (Home & Cell)
Names & Ages of Siblings (if any): ______
Does your child have food allergies?
□ Nuts □ Dairy □ Eggs □ Wheat □ Gluten Other: ______
Does your child have non-food allergies?
□ Grass □ Hay □ Pollen □ Pet Hair □ Insect bites/stings Other: ______
What is the reaction?
Severe (anaphylactic) □ Slight (rash, irritation, upset stomach) □ Mild (itchy, rash, runny nose)
Special Instructions regarding allergies: ______
What opportunities has your child had to be independent?
□ Mom’s Group □ Other Preschool □ Sunday School □ Play Group □ Babysitter Other ______
Does your child have trouble with separation anxiety? □ Yes □ No
If so what helps?
□ Not sure □Redirection □ Talking about family □Favorite Pet □ Pictures of Mom
Other______
How important are these concepts for your child to learn while at PP?
Extremely Somewhat Slightly
Socializing with peers/ playtime □ □ □
Getting school ready: following directions, being a good listener □ □ □
Learning academics: basic letter names & sounds, pre-reading, science, early math □ □ □
Fine arts: music & music making, arts & crafts, dance & movement □ □ □
GETTING TO KNOW YOUR CHILD
*Please keep in mind that every child develops at their own pace and this is merely a helpful tool for our teachers and registrar in preparing classes.
My child crawls and pulls up on everything!
□ Always □ Sometimes □ Not yet □ N/A
My child is walking and/or running everywhere!
□ Always □ Sometimes □ Not yet □ N/A
My child can feed themselves independently.
□ Always □ Sometimes □ Not yet □ N/A
My child still uses their mouth to explore new things.
□ Always □ Sometimes □ Not yet □ N/A
My child has sat in chairs and does well.
□ Always □ Sometimes □ Not yet □ N/A
My child uses the potty.
□ Always □ Sometimes □ Not yet □ N/A
My child likes to sit and listen to stories.
□ Always □ Sometimes □ Not yet □ N/A
My child can communicate what they want to me.
□ Always □ Sometimes □ Not yet □ N/A
My child has trouble with separation anxiety.
□ Always □ Sometimes □ Not yet □ N/A
Last things you might like to know about my child.
______
I give permission for ______(child’s name) to participate in Parents’ Place activities. I waive and release any and all rights and claims for damages I or my child may have against Parents’ Place and its representatives for any and all injuries suffered by my child during any Parents’ Place activity.
(Photo release)
Thank you and we are looking forward to the 2013-2014 school year!