Parent QuestionnairePlease describe the persons or programs that have cared for your child until now.Does your child have disabilities, allergy, or problems that we should know about in planning for your child? If so please describe:Most small children are afraid of some things. Please state your child’s fears, if any (i.e. darkness, animals, sirens, being left some place without family, etc.)Please describe your child’s favorite activities, favorite food and favorite hobbies.Would you say your child is exceptionally withdrawn, shy, overactive, and or hard to manage? If so, please describe the problems and what is usually done about it. This information will be very helpful for us in planning for your childDoes your child have habits, needs, schedules, or areas you think we should know about in attempting to personalize our approach?Naps: Does your Child nap regularly? Occasionally? Do you try to make him/her? Do you let him/her decide?Does your child have a tensional outlet such as thumb sucking, nail biting, head banging, hair pulling, biting etc.? Please describe:Is your child right or left-handed? If not does he/she show a preference for either hand?Is your child toilet trained? Yes No Day & Night? Yes No Does he / she ever use diapers? Yes No How does he/she reacts to accidents? If he or she is not trained yet are you still working on it? Yes No How do you feel about toilet training accidents?How do you deal with accidents?What does your child say when he/she wants to go to the bathroom?For urinating? Bowel movements? How do you feel your child usually reacts to new situations?What do you hope to gain for yourself or your child from this childcare program?Is there anything else we should know about your child? Please describe your child as you see him/her.Have you given us more than one emergency number? Yes No Is the person likely to be there if called? Yes No Do they know we have been given their number for this use? Yes No
