Family Information FormPlease fill out the form below to help your child’s teacher and our staff get to know your child. Child's Name * First Name Last Name Child's Birth Date * MM DD YYYY Child's Gender * Boy Girl Parent's Names * Parent #1's Occupation/Employer Parent #2's Occupation/Employer Does your child have any special needs? Has your child had a serious illness, surgery or hospital stay? If so, please describe. Is your child taking regular medication(s)? Please describe. Does your child have any allergies? To what substances? How are the allergies manifested (hay fever, hives, vomiting, shock, etc.)? If your child requires and Epi Pen or an Inhaler, you must provide the Preschool with a Health Care Plan from the child's physician. Does your child have any dietary restrictions? Please describe. Please list your child's siblings (names and ages). Please list any other adults in the household (names and relationship to the child). Please list any other significant person in your child's life (i.e., babysitter, grandparents, stepfamilies, etc.). Does your family have a pet/pets? Please list the kind. If your family has a pet/pets, does your child help care for it? What group experiences has your child had with other children? How does your child respond to being left? What are your child's favorite play activities? What methods of discipline have you found most effective? How does your child react? What fears does your child have and how are they expressed? What do you and your child enjoy doing together? Please list any special interests or hobbies (individual or family) which you might share in the preschool classroom. Does your child speak plainly so that others (besides those at home) can understand? Are any foreign languages spoken in the home? Please give any additional information you think might be important for us to have. What hopes and expectations do you have for your child in this preschool experience? Thank you!
