Author: Kathryn Aitcheson

All About Me-Bouncy Bunnies
Name of Child:______________________________________________________________________________
Date of Birth:____________________________________Present Age:___________________Gender:________
Mother’s Name:_____________________________________________________________________________
Fathers Name:______________________________________________________________________________
What other Preschools/Child Care programs has your child attended: ___________________________________
List other children in the home:
First Name Age Grade in School
__________________________________________________________________________________________
__________________________________________________________________________________________
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The following questions are designed to help us better understand your child in order to meet he/her needs:
Briefly describe an ordinary day in the life of your child:
What is your child’s favorite toy?_______________________________________________________________
What is your child’s favorite song?______________________________________________________________
What is your child’s favorite bible story?__________________________________________________________
What is your child’s favorite pet?_______________________________________________________________
What’s your favorite sport (for JJJ):_____________________________________________________________
Who is your child’s favorite person?_____________________________________________________________
What is your child’s favorite book?______________________________________________________________
Does your child have any particular habit or mannerism, such as thumb sucking, nail biting? Please describe:
Does your child have any particular fears such as dogs, sirens, thunder, etc. Please describe:
Does your child have any particular words or expressions that may not be understood by an outsider? Or speak a second language or uses sign language?
In general, how does your child react to anxiety or a stressful situation? Does he/she cry, withdraw, throw tantrums, etc. ?
Has your child had any previous child care experience? If yes, please describe:
What is your accustomed mode of reassuring and rewarding your child?
Is your child talkative, quite or in between?_______________________________________________________________
Are there additional circumstances regarding your child’s physical or emotional status that you want us to be aware of?
Does your child eat well independently? Yes____ No___
Is your child allergic to certain foods? If so, please list and describe the reaction.
Does your child have other allergies? Please list.
Is your child toilet trained for ________Urine _______Bowels? How does she/he tell you they have to use the bathroom?
How frequently does he/she have a bowel movement?____________________________
How frequently do accidents occur?___________________________________________
Does your child sleep well? ___Yes ___No. Does she/he usually nap?______ How long and when?_____________
24. Is there anything else in your child’s development that you think we should know? Any special concerns or needs? Is your child under the care of any type of specialist? If yes, please describe: