Parent Questionnaire CommentsThis field is for validation purposes and should be left unchanged.Child's Name* First Last Please list and describe the persons or programs that have provided care for your child until now.*List the children in your family (please include names and ages).*Does your child have any DIETARY RETRICTIONS?* Yes No What are your child's dietary restrictions?*Does your child have any special fears? (dogs, bugs, sirens, etc.)* Yes No What are your child's fears?*Please list your child’s likes and dislikes.*Does your child have any special hearing, vision, or other medical problems that we should be aware of?* Yes No What are your child's special hearing, vision, or other medical problems?*Does your child have any other special concerns that we should we aware of?* Yes No Of what special concerns should we be aware?*Is your child right or left-handed?* Right Left Both Not Sure How does your child express toilet needs?*How do you deal with potty accidents?*Does your child need any assistance with dressing/undressing or with toileting/washing hands?*How would you describe your child’s personality?*What method of guidance (behavior control) do you use in your home?*Is your child receiving any special services? If so, where? (ex. speech, occupational therapy, etc.)*Is there any additional information that you feel would be beneficial to the staff?*Parent Name* First Last Email* ***Parents-please let us know if you have any special talents, interests, skills that we would be able to use in the preschool ALL INFORMATION SHALL BE REGARDED AND HANDLED CONFIDENTIALLY Δ
