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New Child Questionnaire
Child's Name
*
First
Middle
Last
Birth Date
*
Month
Day
Year
Nickname(s)
In case of an emergency, The Cedarhouse School should call:
Name
*
Relationship
*
Phone
*
Family Information
Sibling 1 Name
Birth Date
Month
Day
Year
Sibling 2 Name
Birth Date
Month
Day
Year
Sibling 3 Name
Birth Date
Month
Day
Year
Excluding parents, names of others living in the home:
Name
Relationship to child
Name
Relationship to child
Pet names and species
Languages spoken in your home
General Information
Describe your child’s temperament (e.g., happy, shy, fearful, fearless, silly).
What signs does your child give of being hungry, tired or over-stimulated (e.g., pulls at ears, rubs eyes)?
How does your child express anger or frustration?
How does your child handle separation from you?
Describe any fears your child has.
When your child is upset, what methods work best to soothe him/her? (e.g., hugs, distraction, back rub, special blanket)
What are your child’s favorite toys, games, books and activities?
Is your child potty trained? What word or action does your child use for going to the potty?
How do you discipline your child?
Does your child take afternoon naps? If so, for how long?
Are you concerned about any specific developmental areas? If so, what are they?
Has your child had an unpleasant experience with any previous childcare situations? Please describe.
For children who are just developing their communication skills, are there key words we should know? (e.g., hungry, eat, dirty diaper, etc.)
Is there anything else we should know about your child? What can we do to make this a comfortable, secure place for him/her?