Child Profile Form Child’s ProfileDate:* MM slash DD slash YYYY Name:* First Last Nickname Birthday:* MM slash DD slash YYYY Gender* Male Female Primary language spoken at home: Other language spoken at home: Brothers or sisters of child, ages: Has your child had previous group experience? Does your child know any other children in the program? How well does your child get along with other children? Does your child show right or left-handed preference? Right Hand Left Hand What is your child’s favorite activity or toy? Does your child share a room? If so, with whom? Does your child take a daily nap? Yes No What time does your child go to bed at night? Does she/he sleep well? Does your child have fears of which you are aware? Does your child have food allergies? What goals do you have for your child this year? How would you describe your child’s personality? What makes your child excited or happy? What makes your child frustrated or upset? How does your child show she/he is upset (cry, withdraw)? List specific techniques which appear to comfort your child: Does she/he have difficulty speaking? Special words your child uses to describe what she/he needs? What words are used for urination and bowel movements? Does your child have any needs requiring special attention? Do you have any special requests? Does either parent have any special resources or skills to offer our children or teachers?* Do you know of any business that would be willing to donate materials or useful equipment to the school?* PhoneThis field is for validation purposes and should be left unchanged.
