How would you describe your child:______________________________________________________________________________
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Previous experience with other children/day care:____________________________________________________________________
Reaction to strangers:______________________________________________Able to play alone:_____________________________
Favorite toys and activities:_____________________________________________________________________________________
Fears (the dark, animals, etc):___________________________________________________________________________________
How do you comfort child?_____________________________________________________________________________________
What is the method of behavior management/discipline at home?________________________________________________________
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What would you like your child to gain from this child care experience?
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Is there anything else you would like us to know about your child?
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Parent/Guardian Signature____________________________________________________________Date______________________