Transition form for Modern Education Family Childcare

Email

example@example.com

This is a right form for infant/toddler.

This is a right form for preschooler.

Child's Name

First NameLast Name

Child's Birthdate

Date

Facility Name

Primary Room

Please describe your child’s usual bedtime routine (including what time and where he/she usually sleeps).

How do you know that your child is sleepy/tired?

Does your child have any difficulties falling asleep?

If yes, what is helpful putting your child to sleep?

About how many hours of uninterrupted sleep does your child get each night?

Does your child nap?

How many times per day does your child nap?

How many hours on average for each nap?

Does your child sleep with a special blanket, toy, pacifier, song?

Do you have any concerns about your child’s sleep habits?

If yes, please explain

Does your child generally enjoy eating?

Do you consider your child a good eater?

What are some of your child’s favorite foods (temperatures, textures, etc.)?

Is your child on any special diet?

If your child has any food allergies, please list here:

Are there any other foods you do not want us to offer your child?

Infant: Do you breastfeed your child?

Infant: If yes, how often do you breastfeed your child?

Preschool: Are there foods from your home/culture that you would like us to offer?

What does your child eat with?

Does your child eat independently?

What does your child use to drink?

Infant: What type of nipple for the bottle?

Do you have any concerns or questions about your child’s eating habits?

If yes, please explain:

Does your child wear diapers?

If yes, what kind of diapers your child wear?

For naps, does your child wear diapers?

If no, does your child use the toilet regularly?

Please explain:

Families use a variety of words to describe bathroom activities. Indicate the words your family uses for:
urine bowel movement genital area

Do you have any questions or concerns about your child’s toileting habits?yes / no If yes, please explain: your concerns or questions

Does your child have a favorite toy/object or song?

Does your child enjoy playing with others? yes / no
Does your child enjoy playing alone?yes / no

What activities and/or toys does your child enjoy?

Does your child have any health problems? If yes, please explain: details

Is your child taking any medication(s) regularly? If yes, please list: details

Does your child have a chronic health condition or specific health needs? (please be specific)

Does your child have frequent ear infections? diarrhea?

Do you have any concerns about your child’s health? If yes, please explain: details

Do you have any concerns about your child’s:

Rows	My concerns
hearing and/or vision?
speech and language development?
ability to move?
overall development?

What languages are spoken at home?

What is your family’s cultural identification (values, traditions)?

Has your child ever been in group care? Yes No If yes, how many different settings?

How does your child respond in group situations?

What can we do to help your child adjust to child care?

How would you describe your child’s temperament?

Infant: How does your child communicate his/her needs?

How do you comfort your child?

Does your child use a special comforting item (such as a blanket, stuffed animal, doll)?

Does your child fear certain things?

How is your child disciplined?

What works best when you discipline your child?

Do you have any concerns about your child’s social-emotional development or behavior? If yes, please explain: Type a label

What educational/developmental experiences would you like us to emphasize with your child (for example, language development, social relationships, kindergarten readiness skills, physical or self-help skills, etc.)?

Child & Family Photos for family-themed activities

A few family photos and individual photos of your child where the face is clearly visible and without a hat.

Signature

Transition form

Sleeping

Eating

TOILETING

Play

Health

General Development

Social and Emotional Development